title: Effects of aural stimulation with capsaicin ointment on swallowing function in elderly patients with non-obstructive dysphagia.
abstract: 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.
  
  
  METHODS
  A prospective pilot, non-blinded, non-controlled study with case series evaluating a new treatment.
  
  
  METHODS
  Secondary hospitals.
  
  
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Otolaryngology, University of Tokushima School of Medicine, Tokushima, Japan ; Department of Otolaryngology, Kochi National Hospital, Kochi, Japan.
authors.forename: Eiji
authors.initials: E
authors.lastname: Kondo
authors.affiliation: Department of Otolaryngology, Anan Kyoei Hospital, Anan, Japan.
authors.forename: Osamu
authors.initials: O
authors.lastname: Jinnouchi
authors.affiliation: Department of Otolaryngology, Anan Kyoei Hospital, Anan, Japan.
authors.forename: Hiroki
authors.initials: H
authors.lastname: Ohnishi
authors.affiliation: Department of Otolaryngology, Anan Kyoei Hospital, Anan, Japan.
authors.forename: Ikuji
authors.initials: I
authors.lastname: Kawata
authors.affiliation: Department of Otolaryngology, Kochi National Hospital, Kochi, Japan.
authors.forename: Seiichi
authors.initials: S
authors.lastname: Nakano
authors.affiliation: Department of Otolaryngology, University of Tokushima School of Medicine, Tokushima, Japan.
authors.forename: Masakazu
authors.initials: M
authors.lastname: Goda
authors.affiliation: Department of Otolaryngology, University of Tokushima School of Medicine, Tokushima, Japan.
authors.forename: Yoshiaki
authors.initials: Y
authors.lastname: Kitamura
authors.affiliation: Department of Otolaryngology, University of Tokushima School of Medicine, Tokushima, Japan.
authors.forename: Koji
authors.initials: K
authors.lastname: Abe
authors.affiliation: Department of Otolaryngology, Kagawa University School of Medicine, Kagawa, Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Hoshikawa
authors.affiliation: Department of Sensori-Motor Integration, National Institute for Physiological Sciences, Okazaki, Japan.
authors.forename: Hidehiko
authors.initials: H
authors.lastname: Okamoto
authors.affiliation: Department of Otolaryngology, University of Tokushima School of Medicine, Tokushima, Japan.
authors.forename: Noriaki
authors.initials: N
authors.lastname: Takeda
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002211:Capsaicin / Q000008:administration & dosage*; D003680:Deglutition Disorders / Q000188:drug therapy*; D004424:Ear Canal / Q000187:drug effects*; D004724:Endoscopy; D005260:Female; D006707:Homes for the Aged; D006801:Humans; D007564:Japan; D008297:Male; D009735:Nursing Homes; D009824:Ointments; D019720:Otoscopes; D010865:Pilot Projects; D011015:Pneumonia, Aspiration / Q000517:prevention & control / Q000628:therapy; D011446:Prospective Studies; D012307:Risk Factors; D014741:Video Recording
chemical_list: D009824:Ointments; D002211:Capsaicin
keywords: Arnold’s ear-cough reflex; external auditory canal; oral food intake; swallowing reflex