title: Prospective phase II study of the efficacy of transcutaneous electrical nerve stimulation in post-radiation patients.
abstract: OBJECTIVE
  To evaluate the effectiveness of transcutaneous electrical nerve stimulation (TENS) delivered using an extra-oral device in patients with radiation-induced xerostomia.
  
  
  METHODS
  Thirty oral cavity and oropharyngeal cancer patients post-adjuvant (n = 26) or definitive radiotherapy (n = 4) were enrolled in this study. The TENS electrode pads were placed externally on the skin overlying the parotid glands. Unstimulated whole saliva was collected for 5 min into graduated tubes using the low forced spitting method. The TENS unit was then activated and stimulated saliva was collected for an additional 5 min. The difference between unstimulated and stimulated saliva output was measured using the paired t-test. Linear regression was used to determine factors significantly influencing the improvement in salivary output.
  
  
  RESULTS
  Twenty-nine of 30 patients showed increased saliva flow during stimulation. A statistically significant improvement in saliva production (P < 0.05) during stimulation was noted. The mean unstimulated saliva flow was 0.056 ml/min and the mean stimulated saliva flow was 0.12 ml/min with a median increase of 0.06 ml/min. The interval to the application of TENS after radiotherapy significantly influenced the improvement in salivary flow.
  
  
  CONCLUSIONS
  Extra-oral application of TENS is effective in increasing the whole salivary flow in most of the post-radiated oral cavity/oropharyngeal cancer patients with xerostomia. TENS therapy may be useful as an effective supportive treatment modality in post-radiated oral cancer patients.
authors.affiliation: Department of Oral Medicine and Radiology, Sri Hasanamba Dental College and Hospital, Hassan, Karnataka, India.
authors.forename: A
authors.initials: A
authors.lastname: Vijayan
authors.affiliation: Department of Oral Medicine and Radiology, Sri Hasanamba Dental College and Hospital, Hassan, Karnataka, India.
authors.forename: M L
authors.initials: ML
authors.lastname: Asha
authors.affiliation: Department of Surgical Oncology, Malabar Cancer Center, Thalassery, Kerala, India.
authors.forename: S
authors.initials: S
authors.lastname: Babu
authors.affiliation: Department of Radiation Oncology, Malabar Cancer Center, Thalassery, Kerala, India. Electronic address: drsantam@gmail.com.
authors.forename: S
authors.initials: S
authors.lastname: Chakraborty
mesh_terms: D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009062:Mouth Neoplasms / Q000532:radiotherapy*; D009959:Oropharyngeal Neoplasms / Q000532:radiotherapy*; D011446:Prospective Studies; D011832:Radiation Injuries / Q000209:etiology / Q000628:therapy*; D011879:Radiotherapy Dosage; D020266:Radiotherapy, Conformal / Q000009:adverse effects / Q000379:methods; D012463:Saliva / Q000378:metabolism; D004561:Transcutaneous Electric Nerve Stimulation / Q000379:methods*; D014987:Xerostomia / Q000209:etiology / Q000628:therapy*
keywords: Head and neck cancer; intensity-modulated radiotherapy; radiotherapy; transcutaneous electrical nerve stimulation (TENS); xerostomia