xRead - Swallowing Disorders in the Adult Patient (October 2024)

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Fig. 1. Average total RCPD Questionnaire scores signi fi cantly decrease from pre-procedure to week 2 post-procedure ( p < 0.0001) and then remain fairly stable at subsequent follow-up points without signi fi cant change ( p > 0.05). There is no signi fi cant difference between OR and IO injection groups ( p = 0.4924). [Color fi gure can be viewed in the online issue, which is available at www.laryngoscope.com.]

2, week 3, and month 3 were signi fi cantly lower than preinjection scores, but after 2 weeks there was no fur ther signi fi cant change. Therefore, patient improvement can be expected to improve and generally stabilize around week 2. Furthermore, no signi fi cant difference in overall symptom reduction was found between the two injection techniques, which is inconsistent with the study group ’ s initial fi ndings showing that OR injections are signi fi cantly more successful. 7 For this reason, further analysis was made by comparing the changes in the fi rst question of the RCPD Questionnaire ( ‘ I am unable to burp ’ ). According to a mixed model, OR injections led to a statis tically signi fi cant improvement in ability to burp com pared with IO injections ( p = 0.0065). These fi ndings indicate that even though patients report more burping after OR injections, change in overall RCPD symptoms does not differ signi fi cantly between groups. Dysphagia is the most common side effect of BTX and has been reported after both IO and OR injec tions. 2,5,7,8 However, previous studies used only unstruc tured patient-reported symptoms. In this study, EAT-10 questionnaires were fi lled out by the patients before treatment and at 1, 2, 3 weeks, and 3 months post treatment to evaluate: (1) preinjection swallowing prob lems, (2) postinjection dysphagia due to BTX injection of the CP, (3) long-term swallowing outcomes of the treat ment. Two authors from this study group (CD and MJP) previously published that postinjection dysphagia was seen in 59.5% after IO and 80.5% after OR injections without statistical signi fi cance. 7 Current results are not binary and prospective, and they show that EAT-10 scores are signi fi cantly increased 1 week postinjection

There was also a statistically signi fi cant difference in GAD-7 scores between pre-op and 3-week follow-up ( p = 0.0018), pre-op and 3-month follow-up ( p = 0.0012), but not between the two follow-up time points ( p = 0.8866). This is seen in Figure 2. GAD-7 scoring did not differ signi fi cantly between OR and IO injection groups ( p = 0.8164). When modelling total EAT10 score, both time after procedure ( p < 0.0001) and procedure type ( p = 0.0108) were observed to have a signi fi cant effect on total EAT10 scores. There was also a signi fi cant interaction between time and procedure type ( p = 0.0081). The largest signi fi cant increase of EAT10 score is observed at week 1 fol low-up, with EAT10 scores for the OR group being signi fi cantly higher than the IO group ( p = 0.0379). This is shown in Figure 3. DISCUSSION The present study prospectively analyzed and com pared success rates, post-operative dysphagia, and effects on anxiety of IO and OR BTX injections for RCPD. Our results showed that although there is no signi fi cant dif ference between success rates, postinjection dysphagia is higher after OR injections. Both treatments signi fi cantly decrease anxiety caused by RCPD symptoms. The effectiveness of BTX injections for RCPD was fi rst shown by Bastian et al. in 2019. 2 Consecutively, other studies for OR 4 – 6 and IO 7,8 injections were publi shed. This study further proved the effectiveness of BTX by showing the decrease in RCPD symptoms using a RCPD questionnaire. Postoperative RCPD scores at week

Laryngoscope 00: 2024

Doruk et al.: Botulinum Toxin Injection for RCPD

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