Cricopharyngeal electromyography: patterns of injury based on etiology

Assessing Upper Esophageal Sphincter Function in Clinical Practice: a Primer

The upper esophageal sphincter constitutes an important anatomic and functional landmark in the physiology of pharyngeal swallowing. A variety of clinical circumstances may call for a dedicated evaluation of this mechanism, from the etiologic evaluation of indeterminate symptoms to the generation of complex locoregional therapeutic strategies. Multiple diagnostic tools exist for the assessment of pharyngeal swallowing generally and of upper esophageal sphincter function specifically, some well established and others not yet settled into routine practice. This report reviews five specific modalities for use in making this assessment, outlining the strengths, weaknesses, and logistical considerations of each with respect to its potential use in clinical settings. In many cases, these studies will provide complementary information regarding pharyngeal function, suggesting the relative advantage of a multimodal evaluation.

Topographic description of an alternative insertion technique for percutaneous approach of cricopharyngeus muscle electromyography: a cadaveric and clinical study

BACKGROUND

Cricopharyngeus is the only muscle for which electromyography is used in the differential diagnosis of swallowing disorders. Because of some practical difficulties, electrophysiologic tests for this muscle are not performed routinely. Thus we aimed to describe an alternative topographic way to reach the muscle easily.

METHODS

On 10 cadavers, a spinal needle (20 G) and on 37 patients a concentric needle electrode (26 G) were used. The needle was inserted percutaneous at the level of the superior border of the cricoid cartilage, anterior to the anterior border of the sternocleidomastoid muscle at 60 degrees angle to the frontal plane in the posteromedial direction.

RESULTS

We reached the muscle in all cadavers. In all of the patients, the needle entered the muscle on the first attempt; that was confirmed by electromyographic responses.

CONCLUSION

Our results show that this method can be useful for the practical application of cricopharyngeus muscle electromyography.

Cricopharyngeal Muscle Electromyography Findings in Patients with Gastroesophageal Reflux Disease

Objective

To analyze the grade of reflux and the behavior of the cricopharyngeal muscle (CPM) in patients with gastroesophageal reflux (GER) by means of electromyographic (EMG) analysis of CPM.

Study Design

Prospective clinical study.

Setting

Istanbul Training and Research Hospital.

Subject and Methods

Motor unit potential (MUP) recordings and kinesiological recordings of CPM were performed using a concentric needle electrode during dry material swallowing and 3-, 5-, and 10-mL water swallowing. Twenty-four patients with GER were compared with 21 healthy volunteers.

Results

GER was mild in 15 patients and moderate-to-severe in 9 patients. MUP recordings were normal in both groups during the preswallowing/postswallowing periods. Kinesiological investigations revealed that the number of patients who did not show a preswallow EMG burst had a positive correlation with the severity of reflux and the amount of liquid swallowed. Rebound bursts were observed in the patient and the control groups. Duration of preswallow and rebound bursts was similar in all groups. Duration of swallowing was shorter in mild GER patients compared with healthy volunteers and moderate-to-severe GER patients. Piecemeal deglutition during 10-mL liquid swallowing was higher in moderate-to-severe GER patients. We also found a positive correlation between the number of swallows and the severity of reflux.

Conclusion

Needle EMG of the upper esophageal sphincter was normal in GER patients. Kinesiological evaluations showed increased piecemeal deglutition and number of swallows that correlated positively with the severity of GER.

Treatment of a patient with glossopharyngeal neuralgia by the anterior tonsillar pillar method

We describe the case of a 65-year-old patient with glossopharyngeal neuralgia. Pain was triggered by swallowing, yawning, or cold food. We used the anterior tonsillar pillar method for the injection of drugs; a relatively new glossopharyngeal nerve (GPN) block which was described by Benumof (Anesthesiology 1991;75:1094-1096). Performing this GPN block, daily levobupivacaine (Chirocaine® 5 mg/ml) and oral amitriptyline (Laroxyl® 10 mg) were given, as well as methylprednisolone acetate injectable suspension (Depo-Medrol® 40 mg/ml) once only at the beginning of the treatment. A 0-10 point visual analogue scale was used daily to evaluate the pain. Pain was successfully controlled with a steroid added to the GPN block and orally administered tricyclic antidepressant. We think that this treatment is effective for glossopharyngeal neuropathy and could be of interest to pain management physicians.