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    Pharyngeal electrical stimulation for neurogenic dysphagia

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    2 The condition, current treatments and procedure

    The condition

    2.1 Difficulty in swallowing (dysphagia) can be caused by neurological impairment affecting the muscles of the pharynx. It can happen because of several conditions, including stroke, traumatic brain injury, disorders of cerebral development, neurodegenerative diseases, major head and neck surgery (for example, to remove cancer), and intensive care treatment (intubation and tracheostomy). Dysphagia may lead to malnutrition, dehydration, aspiration pneumonia and death.

    Current treatments

    2.2 Treatment options depend on the cause and severity of the dysphagia. Typical management includes diet modification (including thicker fluids and foods) and swallowing therapy (to help relearn swallowing, and strengthen muscles). Transcutaneous neuromuscular electrical stimulation has also been used for pharyngeal dysphagia. In moderate or severe cases, nasogastric tubes, or percutaneous endoscopic gastrostomy or jejunostomy tubes, may be used to provide nutritional support.

    The procedure

    2.3 A catheter with 2 electrodes on the outside is passed through the nose into the pharynx. Guide marks on the catheter are used to ensure it is correctly positioned to deliver low-level pharyngeal electrical stimulation. The catheter is connected to a portable base station, which stores patient information and adjusts the stimulation variables. The exact stimulation level is calculated on an individual basis at the start of each treatment session. Treatment is given by a healthcare professional with appropriate training and typically consists of 10 minutes of stimulation each day for 6 consecutive days. People may experience a fizzing or tingling sensation in the throat during the procedure. The focused stimulation aims to increase brain activity in the swallowing control centre and restore neurological control of the swallowing function. The dual function catheter enables administration of enteral nutrition and fluids, if needed, as well as delivering electrical stimulation.