Hu Kai-Hsiang, Lee I-Pei, Tsai Shu-Wei, Hung David Shang-Yu, Hsieh Miyuki Hsing-Chun, Chen Yi-Jen, Hsiao Jenn-Ren, Huang Cheng-Chih, Ou Chun-Yen, Chang Chan-Chi, Lee Wei-Ting, Tsai Sen-Tien, Su Hui-Chen
Education Center, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
Department of Otolaryngology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
Dysphagia. 2025 Aug 7. doi: 10.1007/s00455-025-10868-6.
To evaluate the effectiveness of botulinum toxin injection in improving swallowing function in patients with cricopharyngeal muscle dysfunction (CPMD) following radiotherapy for nasopharyngeal carcinoma (NPC). Cohort study. Outpatients with NPC-related CPMD receiving endoscopy-guided botulinum toxin injection at National Cheng Kung University Hospital between 2017-2024. 15 NPC patients with CPMD were enrolled. Swallowing function was assessed using the functional oral intake scale (FOIS), penetration-aspiration scale (PAS), bolus residue scale (BRS), dynamic imaging grade of swallowing toxicity (DIGEST), normalized residue ratio scale for vallecular (NRRS_V) and pyriform sinus (NRRS_P), laryngeal elevation, epiglottic retroflexion, pharyngeal contraction ratio(PCR), bolus clearance ratio (BCR), and temporal swallowing parameters (oral transit time [OTT], pharyngeal response time [PRT], pharyngeal delay time [PDT], pharyngeal transit time [PTT], laryngeal elevation delay time [LEDT]). The Wilcoxon signed-rank test was used to compare pre- and post-injection data. FOIS significantly improved after botulinum toxin injection (p = 0.0002). Objective measures showed a significant reduction in NRRS_P (p = 0.0067). Temporal characteristics also demonstrated significant improvement in OTT, PRT, and PTT (p = 0.0156, p = 0.0303, p = 0.0284, respectively). However, other objective measures showed no significant changes. Botulinum toxin injection may benefit specific swallowing parameters, such as NRRS_P, OTT, PTT, and PRT, and enhance FOIS in NPC patients with radiation-induced CPMD. However, its overall impact on swallowing function remains uncertain.
评估肉毒杆菌毒素注射对鼻咽癌（NPC）放疗后环咽肌功能障碍（CPMD）患者吞咽功能改善的有效性。队列研究。2017年至2024年期间在国立成功大学医院接受内镜引导下肉毒杆菌毒素注射的与NPC相关的CPMD门诊患者。纳入15例患有CPMD的NPC患者。使用功能性经口摄入量表（FOIS）、渗透-误吸量表（PAS）、食团残留量表（BRS）、吞咽毒性动态成像分级（DIGEST）、会厌谷归一化残留率量表（NRRS_V）和梨状窝归一化残留率量表（NRRS_P）、喉提升、会厌后倾、咽收缩率（PCR）、食团清除率（BCR）以及吞咽时间参数（口腔运送时间[OTT]、咽部反应时间[PRT]、咽部延迟时间[PDT]、咽部运送时间[PTT]、喉提升延迟时间[LEDT]）评估吞咽功能。采用Wilcoxon符号秩检验比较注射前后的数据。肉毒杆菌毒素注射后FOIS显著改善（p = 0.0002）。客观测量显示NRRS_P显著降低（p = 0.0067）。时间特征方面，OTT、PRT和PTT也有显著改善（分别为p = 0.0156、p = 0.0303、p = 0.0284）。然而，其他客观测量结果无显著变化。肉毒杆菌毒素注射可能有益于特定的吞咽参数，如NRRS_P、OTT、PTT和PRT，并提高放疗引起的CPMD的NPC患者的FOIS。然而，其对吞咽功能的总体影响仍不确定。
