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

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on patient preference after discussion of options. The study results could have also been affected by a nonre sponse bias for patients who failed to complete all their surveys. Then, 36 patients completed the 3 months sur vey which could mask minor difference between the effec tiveness of OR and IO injections. CONCLUSION The results of this study support equal effectiveness for IO and OR injections for RCPD. A larger long-term study is needed to determine if smaller variations in out come exist between the two techniques. Postinjection dys phagia is common with both in IO and OR but more severe after OR injection, speci fi cally during the fi rst week. RCPD patients suffer from anxiety, which is signi fi cantly improved after RCPD treatment. Future studies will be needed to evaluate long-term results, recurrence of symptoms after complete resolution, and results from repeat injections with no or partial response. BIBLIOGRAPHY 1. Kahrilas PJ, Dodds WJ, Hogan WJ. Dysfunction of the belch re fl ex. Gastro enterology . 1987;93(4):818-822. https://doi.org/10.1016/0016-5085(87) 90445-8. 2. Bastian RW, Smithson ML. Inability to belch and associated symptoms due to retrograde cricopharyngeus dysfunction: diagnosis and treatment. OTO Open . 2019;3(1):2473974X19834553. 3. Miller ME, Lina I, O ’ Dell K, Akst LM. Experiences of patients living with retrograde Cricopharyngeal dysfunction. Laryngoscope . 2023;134:2136 2143. https://doi.org/10.1002/lary.31157. 4. Hoesli RC, Wingo ML, Bastian RW. The long-term ef fi cacy of botulinum toxin injection to treat retrograde cricopharyngeus dysfunction. OTO Open . 2020;4(2):2473974X20938342. 5. Siddiqui SH, Sagalow ES, Fiorella MA, Jain N, Spiegel JR. Retrograde Cricopharyngeus dysfunction: the Jefferson experience. Laryngoscope . 2022;133(5):1081-1085. 6. Karagama Y. Abelchia: inability to belch/burp — a new disorder? Retrograde cricopharyngeal dysfunction (RCPD). Eur Arch Otorhinolaryngol . 2021; 278(12):5087-5091. 7. Doruk C, Pitman MJ. Lateral Transcervical in-of fi ce botulinum toxin injec tion for retrograde Cricopharyngeal dysfunction. Laryngoscope . 2024; 134(1):283-286. https://doi.org/10.1002/lary.30871. 8. Wajsberg B, Hoesli RC, Wingo ML, Bastian RW. Ef fi cacy and safety of electromyography-guided injection of botulinum toxin to treat retrograde Cricopharyngeus dysfunction. OTOOpen . 2021;5(1):2473974X21989587. 9. Harris PA, Taylor R, Thielke R, Payne J, Gonzalez N, Conde JG. Research electronic data capture (REDCap) — a metadata-driven methodology and work fl ow process for providing translational research informatics support. J Biomed Inform . 2009;42(2):377-381. https://doi.org/10.1016/j.jbi.2008. 08.010. 10. Harris PA, Taylor R, Minor BL, et al. The REDCap consortium: building an international community of software platform partners. J Biomed Inform . 2019;95:103208. https://doi.org/10.1016/j.jbi.2019.103208. 11. Belafsky PC, Mouadeb DA, Rees CJ, et al. Validity and reliability of the eat ing assessment tool (EAT-10). Ann Otol Rhinol Laryngol . 2008;117(12): 919-924. https://doi.org/10.1177/000348940811701210. 12. Hoffman MR, Schiffer B, Patel RA, Smith ME. “ I ’ ve never been able to burp ” : preliminary description of retrograde cricopharyngeal dysfunction in children. Int J Pediatr Otorhinolaryngol . 2022;161:111261.

compared with preinjection ( p < 0.0001) and are signi fi cantly higher in the OR group when compared with IO injections ( p = 0.0267). This difference is likely due to the use of higher dose and volume of BTX during OR injec tions, with BTX diffusion to inferior constrictors and cer vical esophagus. Further studies will be necessary to see if equivalent ef fi cacy can be obtained in the operating room at a lower dose, such as 30 U, with a decrease in the postoperative dysphagia burden for these patients. It is important to note that IO BTX dosing was 30 U compared with 80 U in the OR. To date, injections from 30 U to 100 U have been reported in the literature, but no standardized dosing has been established. 2,4 – 7 Then, 80 U were injected in the OR since 20 U are wasted in drawing up the BTX from a 100 U vial and priming the injector needle. For the of fi ce procedure dosing, author MP originally chose this dose as it is the typical dose he uses for successful OR cricopharygeal BTX injection for dysphagia. In addition, the lower volume was felt to decrease the risks of diffusion and inadvertent PCA pare sis or paralysis. MP and CD have previously shown the ef fi cacy of the lateral transcervical approach with 30 U BTX, so the decision was made to directly compare this dosing to the 80 U OR dosing. 7 Certainly, discovering the optimal BTX dosing that minimizes side effects, whereas providing ef fi cacy will be important for future studies to explore. The symptoms associated with RCPD can lead to anxiety, social isolation, and loss of productivity. 3 These symptoms are often present since adolescence or even childhood. 12 According to Miller et al., the most debilitat ing symptoms are bloating and gurgling noises, which can cause uncomfortable social situations for patients. Individuals with RCPD may avoid eating at restaurants or eating food or beverage that increase symptoms (i.e. carbonated drinks). Thus, the quality of life can be severely affected in this patient population. This study evaluated how anxiety levels are affected with treatment. Average pretreatment GAD-7 score was 6.83, which scores as mild anxiety. At 3 months, the average GAD-7 score dropped to 3.81 which falls in the minimal anxiety category. This study is not without limitations. The current results are limited to 3 months posttreatment and does not include long-term follow-up. The study does not eval uate complication rates, the results of a second injection in patients with no or partial response to their primary injection, or rate of repeat injections with symptom recur rence after initial resolution. The need and ef fi cacy for repeat injections should be explored in future studies. The treatment arms are not randomized but rather based

Laryngoscope 00: 2024

Doruk et al.: Botulinum Toxin Injection for RCPD

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