[Aural Stimulation with Capsaicin Ointment Improved the Swallowing Function in Patients with Dysphagia: Evaluation by the SMRC Scale].

Cough and swallowing reflexes are important airway-protective mechanisms against aspiration. Angiotensin-converting enzyme (ACE) inhibitors, one of the side effects of which is cough, have been reported to reduce the incidence of aspiration pneumonia in hypertensive patients with stroke. ACE inhibitors have also been reported to improve the swallowing function in post-stroke patients. On the other hand, stimulation of the Arnold nerve, the auricular branch of the vagus, triggers the cough reflex (Arnold's ear-cough reflex). Capsaicin, an agonist of Transient Receptor Potential Vanilloid 1 (TRPV1), has been shown to activate the peripheral sensory C-fibers. Stimulation of the sensory branches of the vagus in the laryngotracheal mucosa with capsaicin induces the cough reflex and has been reported to improve the swallowing function in patients with dysphagia. In our previous study, we showed that aural stimulation of the Arnold nerve with 0.025% capsaicin ointment improved the swallowing function, as evaluated by the endoscopic swallowing score, in 26 patients with dysphagia. In the present study, the video images of swallowing recorded in the previous study were re-evaluated using the SMRC scale by an independent otolaryngologist who was blinded to the information about the patients and the endoscopic swallowing score. The SMRC scale is used to evaluate four aspects of the swallowing function: 1) Sensory: the initiation of the swallowing reflex as assessed by the white-out timing; 2) Motion: the ability to hold blue-dyed water in the oral cavity and induce laryngeal elevation; 3) Reflex: glottal closure and the cough reflex induced by touching the epiglottis or arytenoid with the endoscope; 4) Clearance: pharyngeal clearance of the blue-dyed water after swallowing. Accordingly, we demonstrated that a single application of capsaicin ointment to the external auditory canal of patients with dysphagia significantly improved the R, but not the S, M or C scores, and this effect lasted for 60 min. After repeated aural stimulation with the ointment for 7 days, the R score improved significantly in patients with severe dysphagia. The present findings suggest that stimulation of the Arnold's branch of the vagus in the external auditory canal with capsaicin improves the glottal closure and cough reflex in patients with dysphagia. Thus, aural stimulation with capsaicin represents a novel treatment for dysphagia. It is also suggested that repeated alternative aural stimulation with capsaicin for a week, rather than a single application, is needed to improve the swallowing function in patients with severe dysphagia. By the same mechanism as that underlying the effect of ACE inhibitors, aural stimulation with capsaicin may reduce the incidence of aspiration pneumonia in patients with dysphagia.

Aural stimulation with capsaicin prevented pneumonia in dementia patients.

OBJECTIVE: In the present study, we examined the effects of daily application of capsaicin ointment to the external auditory canal for 6 months on the development of pneumonia in elderly dementia patients at high risk of aspiration. METHODS: Twenty-nine oldest-old bedridden dementia inpatients at high risk of aspiration were enrolled in the present study. Ointment containing 0.025% capsaicin was applied to each external auditory canal with a cotton swab alternatively once a day for 6 months. RESULTS: The incidence of pneumonia during the 6 months before the intervention was 1.80±0.37 in these patients. However, this incidence significantly decreased to 0.40±0.29 (p<0.01) during the 6 months of the alternative application of capsaicin ointment to each auditory canal. No adverse effect such as otalgia was observed. CONCLUSION: These findings suggest that daily long-term aural stimulation with capsaicin ointment enhanced the cough reflex via Arnold's ear-cough reflex as a glottis protective measure, resulting in the reduction of incidence of pneumonia in elderly dementia patients at high risk of aspiration. The daily aural stimulation with capsaicin ointment may be a safe and promising intervention to prevent aspiration pneumonia in elderly people, especially those who cannot undergo swallowing exercise.

Daily auricular stimulation with capsaicin ointment improved cough reflex sensitivity in elderly patients with dysphagia: a pilot study.

Background: In our previous study, a single auricular application of capsaicin ointment, but not placebo improved cough reflex in elderly patients with dysphagia.Aims/Objectives: In the present study, we examined whether daily auricular application of capsaicin ointment continued to improve cough reflex in similar patients.Material and methods: With a cotton swab, 0.025% capsaicin ointment was applied in each external auditory canal alternately once a day for 2 weeks. The cough reflex sensitivity was evaluated on videoendoscopy using a numerical score and inhalation cough challenge test using citric acid in elderly dysphagic inpatients.Results: After daily auricular application of capsaicin ointment for 2 weeks, the endoscopic score of glottal closure and cough reflexes significantly improved, and the citric acid cough threshold significantly decreased. There was a significant correlation between the endoscopic score and the citric acid cough threshold before and after daily capsaicin application in the patients.Conclusions: Daily auricular stimulation with capsaicin ointment for 2 weeks continued to improve the cough reflex sensitivity in elderly patients with dysphagia.Significance: Daily auricular stimulation with capsaicin ointment would be a safe and effective intervention to prevent pneumonia in elderly with a risk of aspiration.

Aural stimulation with capsaicin ointment improved swallowing function in elderly patients with dysphagia: a randomized, placebo-controlled, double-blind, comparative study.

OBJECTIVE: The aim of this study was to assess whether aural stimulation with ointment containing capsaicin improves swallowing function in elderly patients with dysphagia. STUDY DESIGN: A randomized, placebo-controlled, double-blind, comparative study. SETTINGS: Secondary hospital. PATIENTS AND METHODS: Twenty elderly dysphagic patients with a history of cerebrovascular disorder or Parkinson's disease were randomly divided into two groups: 10 receiving aural stimulation with 0.025% capsaicin ointment and 10 stimulated with placebo. The ointments were applied to the external auditory canal with a cotton swab. Then, swallowing of a bolus of blue-dyed water was recorded using transnasal videoendoscopy, and the swallowing function was evaluated according to both endoscopic swallowing scoring and Sensory-Motor-Reflex-Clearance (SMRC) scale. RESULTS: The sum of endoscopic swallowing scores was significantly decreased 30 and 60 min after a single administration in patients treated with capsaicin, but not with placebo. Reflex score, but not Sensory, Motion and Clearance scores, of the SMRC scale was significantly increased 5, 30 and 60 min after single administration in patients treated with capsaicin, but not with placebo. No patient showed signs of adverse effects. CONCLUSION: As capsaicin is an agonist of the transient receptor potential vanilloid 1 (TRPV1), these findings suggest that improvement of the swallowing function, especially glottal closure and cough reflexes, in elderly dysphagic patients was due to TRPV1-mediated aural stimulation of vagal Arnold's nerve with capsaicin, but not with a nonspecific mechanical stimulation with a cotton swab.

Adenoid cystic carcinoma of maxillary sinus with metastatic hepatocellular carcinoma. Case report.

A case of collision tumor in the left maxillary sinus composed of adenoid cystic carcinoma (ACC) and metastatic hepatocellular carcinoma (HCC) is reported. Radiographic examination revealed masses in the liver and bilateral lung metastases. Histologically, proliferation of tumor cells with resemblance to HCC was observed, in addition to the ACC. For this reason, differential diagnosis between a second primary tumor and metastasis was made. The metastatic lesion immunohistochemically showed positivity for hepatocyte antigen (OCH1E5) and protein induced by vitamin K absence or antagonist II (PIVKA-II), sustaining the HCC diagnosis. Primary ACC and metastatic HCC in the maxillary sinus are rare, and this may therefore be the first case of maxillary sinus tumor with both these elements.

Efficacy of percutaneous endoscopic gastrostomy on unplanned treatment interruption and nutritional status in patients undergoing chemoradiotherapy for advanced head and neck cancer.

OBJECTIVE: Efficacy of percutaneous endoscopic gastrostomy (PEG) on unplanned treatment interruption and nutritional status was examined in patients undergoing chemoradiotherapy (CRT) for advanced head and neck cancer. METHODS: We retrospectively reviewed hospital charts of 44 patients with advanced head and neck cancer who were treated with CRT. RESULTS: CRT-induced mucositis of grade 3 or worse and inadequate oral intake of less than one third of their usual intake developed in 33 patients who were recommended PEG placement, but not in 11 patients. Thirteen patients accepted PEG placement and then completed CRT (compliant group). However, among 20 patients who refused both PEG and nasogastoric tube (NGT) placements (non-compliant group), 10 required unplanned interruptions of CRT at a radiation dose around 30-40 Gy (UI-CRT group) while 10 others could complete CRT without interruption (C-CRT group) CRT. Total serum protein levels were significantly decreased after CRT in all patients. DISCUSSION: It is suggested that therapeutic PEG placement is useful for preventing unplanned interruption of CRT in patients with advanced head and neck cancer. After severe mucositis and inadequate oral intake have developed during CRT, PEG placement should be considered before the radiation therapy dose of 30 Gy.

Gene expression of D-amino acid oxidase in cultured rat astrocytes: regional and cell type specific expression.

Neuromodulative free D-serine is present in mammalian brain, and localized to type-2 astrocytes in culture. D-amino acid oxidase (DAO) is a flavoenzyme that catalyzes D-amino acids. We examined the DAO gene expression in cultured rat astrocytes by reverse transcriptase-polymerase chain reaction. We established a method to prepare highly purified culture of type-1 and type-2 astrocytes from any brain region. This method utilizes combination of cell type specific separation by shaking and subsequent purification by immunopanning or treatment with cytosine arabinoside. We detected higher DAO gene expression in type-1 astrocyte cultures from cerebellum than that from cerebral cortex. In cerebellum, we observed higher DAO expression in type-1 astrocyte cultures than that in type-2. We also revealed that DAO expression in C6, corresponding to type-1 astrocyte, was higher than that in CG-4 derived type-2 astrocytes.

Effects of aural stimulation with capsaicin ointment on swallowing function in elderly patients with non-obstructive dysphagia.

OBJECTIVE: In the present study, an attempt was made to examine the effects of aural stimulation with ointment containing capsaicin on swallowing function in order to develop a novel and safe treatment for non-obstructive dysphagia in elderly patients. DESIGN: A prospective pilot, non-blinded, non-controlled study with case series evaluating a new treatment. SETTING: Secondary hospitals. PATIENTS AND METHODS: The present study included 26 elderly patients with non-obstructive dysphagia. Ointment containing 0.025% capsaicin (0.5 g) was applied to the external auditory canal with a cotton swab under otoscope only once or once a day for 7 days before swallowing of a bolus of colored water (3 mL), which was recorded by transnasal videoendoscopy and evaluated according to the endoscopic swallowing score. RESULTS: After a single application of 0.025% capsaicin ointment to the right external auditory canal, the endoscopic swallowing score was significantly decreased, and this effect lasted for 60 minutes. After repeated applications of the ointment to each external auditory canal alternatively once a day for 7 days, the endoscopic swallowing score decreased significantly in patients with more severe non-obstructive dysphagia. Of the eight tube-fed patients of this group, three began direct swallowing exercises using jelly, which subsequently restored their oral food intake. CONCLUSION: These findings suggest that stimulation of the external auditory canal with ointment containing capsaicin improves swallowing function in elderly patients with non-obstructive dysphagia. By the same mechanism used by angiotensin-converting enzyme inhibitors to induce cough reflex, which has been shown to prevent aspiration pneumonia, aural stimulation with capsaicin may reduce the incidence of aspiration pneumonia in dysphagia patients via Arnold's ear-cough reflex stimulation.

Signal shape feature for automatic snore and breathing sounds classification.

Snore analysis techniques have recently been developed for sleep studies. Most snore analysis techniques require reliable methods for the automatic classification of snore and breathing sounds in the sound recording. In this study we focus on this problem and propose an automated method to classify snore and breathing sounds based on the novel feature, 'positive/negative amplitude ratio (PNAR)', to measure the shape of the sound signal. The performance of the proposed method was evaluated using snore and breathing recordings (snore: 22,643 episodes and breathing: 4664 episodes) from 40 subjects. Receiver operating characteristic (ROC) analysis showed that the proposed method achieved 0.923 sensitivity with 0.918 specificity for snore and breathing sound classification on test data. PNAR has substantial potential as a feature in the front end of a non-contact snore/breathing-based technology for sleep studies.

Anti-microbial and therapeutic effects of modified Burow's solution on refractory otorrhea.

OBJECTIVE: Burow's solution, which contains 13% aluminum acetate, has been shown to be effective against chronic otitis media. Since the preparation of Burow's solution is time-consuming, its rapid preparation method has been recently developed. In this study, we evaluated the therapeutic effects of the modified Burow's solution on refractory otorrhea in patients with chronic suppurative otitis and its anti-microbial activity in vitro. METHODS: Fourteen ears of 12 patients with chronic otitis media, granular myringitis, otitis externa and postoperative mastoid cavity problems were treated topically with cotton swab/ball soaked with modified Burow's solution or its four-fold diluted ear drops once a week. We then examined the antimicrobial spectrum of modified Burow's solution against clinical bacterial isolates from otorrhea and laboratory bacterial strains in vitro. RESULTS: In all ears, refractory otorrhea disappeared after 1-17 weeks treatment of modified Burow's solution with a mean of 5.4 weeks without apparent side-effects such as ototoxicity. Modified Burow's solution inactivated all Gram positive bacteria within 5min except Enterococcus species, all Gram negative bacteria including Pseudomonas aeruginosa within 30s and Candida albicans within 2min. In addition, modified Burow's solution inactivated MRSA completely within 5min, while 80.6% of MRSA survived even a 20-min contact with 0.3% ofloxacin. CONCLUSION: These findings indicate that modified Burow's solution, in addition to bearing a broad antimicrobial activity, is as effective as the original Burow's solution in the treatment of chronic suppurative otitis.