Videofluoroscopic and manometric outcomes of cricopharyngeus balloon dilation for treatment of pharyngo‐esophageal dysphagia associated with nasopharyngeal cancer: A case series

• Published in: Laryngoscope investigative otolaryngology 2021-10, Vol.6 (5), p.1077-1087
• Main Authors: Fong, Raymond, Rumbach, Anna F., Ward, Elizabeth C., Doeltgen, Sebastian H., Sun, Nikie, Tsang, Raymond
• Format: Article
• Language: English
• Subjects: balloon dilation; Biomechanics; Cancer; Catheters; Dysphagia; Esophagus; high resolution manometry; Laryngology, Speech and Language Science; nasopharyngeal cancer; Original Research; Ostomy; Patients; Population; Quality of life; Speech therapists; Swallowing; Throat cancer; Topography; Videofluoroscopy
• ISSN: 2378-8038; 2378-8038
• DOI: 10.1002/lio2.641

Background Problems with pharyngo‐esophageal bolus flow have been reported following nasopharyngeal cancer (NPC) treatment. While studies using videofluoroscopic assessment have shown balloon dilation can help address this impairment, the impact of dilation on pressure and bolus flow characteristics incorporating high‐resolution pharyngeal manometry (HRPM) has not been reported. Methods Five cases with pharyngo‐esophageal dysphagia post NPC underwent balloon dilation. Videofluoroscopic swallowing study (VFSS) and HRPM were completed before and 1 month post dilation. Oral intake and dysphagia related quality of life were reported to 3 months. Results VFSS, manometry and functional outcomes revealed positive benefits from dilation in two cases. In the other three cases, two showed improvements on VFSS only. These three failed to make functional swallowing gains. Conclusions Where there was functional gain, both fluoroscopy and HRPM recorded improvement to UES function. Across the cases, response to dilation was variable and further work is needed to determine which patients would receive most benefit. Level of Evidence 4. The article is the report of a case series on 5 patients with nasopharyngeal cancer with balloon dilation performed. The article presents the outcomes from high resolution manometry (HRM), videofluoroscopic swallow study and functional swallow outcomes. This was the first study using HRM in the clinical population of nasopharyngeal cancer and as an outcome tool for dysphagia treatment and one of the very few treatment studies for dysphagia after chemo‐radiation therapy for nasopharyngeal cancer.