New technique helps ease problem with swallowing in man with SMA
Report is first to describe use of the technique with a neuromuscular disorder
The practice of vacuum swallowing, a maneuver involving effort that’s intended to aid the movement of food through the throat, helped a man with spinal muscular atrophy (SMA) who had dysphagia, a swallowing impairment.
“This is the first report of successful instruction and acquisition of vacuum swallowing in a patient with a neuromuscular disorder,” the researchers wrote in “A Case of a Patient With Spinal Muscular Atrophy With Dysphagia Who Acquired Vacuum Swallowing.” The report was published in Cureus.
The muscle weakness and wasting that characterize SMA can affect the muscles in the tongue, jaw, throat, and neck that are needed for swallowing, which can leading to dysphagia.
During swallowing, food moves through the throat, or pharynx, then the esophagus before making its way to the stomach via muscle contractions. Between the pharynx and the esophagus is the upper esophageal sphincter (UES), a valve that opens to allow food through, but prevents it from flowing back toward the pharynx.
Vacuum swallowing is a relatively recent approach for managing dysphagia that works to compensate for impairments in the pharynx and UES muscles by creating a pressure gradient between the pharynx and esophagus during swallowing to force food toward the stomach.
The technique has been effective for easing dysphagia in people with a condition called lateral medullary syndrome, but the benefits in neuromuscular diseases like SMA haven’t been established. Here, researchers described its successful application in a 67-year-old man with SMA who had developed dysphagia seven years before, leading to a feeding tube being placed. A procedure called a balloon dilation had also been used to help relieve impairments in the UES opening. The man came to the researchers’ hospital with a leg fracture.
Vacuum swallowing for dysphagia
An exam revealed muscle weakness and wasting in the face and tongue, and the man had moderate dysphagia with severe aspiration, where food is inhaled into the airways instead of being swallowed. While he could eat by mouth, it took more than an hour and swallowing saliva was difficult for him.
A videoscope revealed the man had reduced contractions in the pharynx and an insufficient passage of food through the UES, along with reduced tongue strength and decreased height from the teeth to the roof of the mouth, called palatal height. He also had incomplete laryngeal elevation, a protective mechanism where the larynx, or voice box, moves upward to prevent food being aspirated into the airways.
The man had another balloon dilation of the impaired UES and immediate improvements followed. A palatal augmentation prosthesis (PAP), a procedure to address the oral issues, was scheduled.
Meanwhile, the man was trained to perform vacuum swallowing. He was told to attempt to inhale air with his mouth closed, called inspiratory effort, for five seconds, where the air would create negative pressure in the chest cavity that would force any food in the pharynx downward during swallowing. This was repeated in 10 daily sets of five repetitions. After about a month of training in vacuum swallowing, the man had the PAP.
Food transit through the pharynx was increased, meal times were reduced to under an hour, and saliva swallowing was improved by the combination of balloon dilation, PAP, and vacuum swallowing. The man also achieved a better nutritional status with a healthier body weight.
A test of the muscles in the esophagus, called manometry, during vacuum swallowing showed an increase in pharyngeal pressure and increased negative pressure in the esophagus, relative to non-vacuum swallowing. Together, these cause food to move downward.
“The acquisition of vacuum swallowing is feasible for patients with neuromuscular disorders,” wrote the researchers, who said careful instructions and repeated practice were critical to the success of the approach. More research is needed to confirm their research, they said.
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