9. Effect of IQoro training in hiatal hernia patients with misdirected swallowing and esophageal retention symptoms.
Hägg M, Tibbling L, Franzén T. Acta Otolaryngol. 2015 Jul;135(7):635–9.
Abstract as published
Conclusion Misdirected swallowing can be triggered by esophageal retention and hiatal incompetence. The results show that oral IQoro screen (IQS) training improves misdirected swallowing, hoarseness, cough, esophageal retention, and globus symptoms in patients with hiatal hernia. Objectives The present study investigated whether muscle training with an IQS influences symptoms of misdirected swallowing and esophageal retention in patients with hiatal hernia. Methods A total of 28 adult patients with hiatal hernia suffering from misdirected swallowing and esophageal retention symptoms for more than 1 year before entry to the study were evaluated before and after training with an IQS. The patients had to fill out a questionnaire regarding symptoms of misdirected swallowing, hoarseness, cough, esophageal retention, and suprasternal globus, which were scored from 0–3, and a VAS on the ability to swallow food. The effect of IQS traction on diaphragmatic hiatus (DH) pressure was recorded in 12 patients with hiatal hernia using high resolution manometry (HRM). Results Upon entry into the study, misdirected swallowing, globus sensation, and esophageal retention symptoms were present in all 28 patients, hoarseness in 79 %, and cough in 86 %. Significant improvement was found for all symptoms after oral IQS training (p < 0.001). Traction with an IQS resulted in a 65 mmHg increase in the mean HRM pressure of the DH.
Relevance to conditions
Dysphagia: Proof of effect of IQoro on mis-directed swallowing.
Hiatus hernia: Proof of effect of IQoro training on hiatal incompetence and several HH symptoms.
Snoring and sleep apnoea: Velum Closure competence is linked to snoring and OSA.
Peer reviewed, Prospective, Cohort pre- and post-study.
To investigate whether muscle training with IQoro influences symptoms of misdirected swallowing and esophageal retention in patients with hiatal hernia.
28 patients, F=14, M=14. Adult, Median age 59 years (range 22–85). All patients had hiatal hernia with misdirected swallowing and esophageal retention symptoms for median 4 years (range 1–28).
IQoro training of duration 3 x 10 seconds three times per day for a duration of 6–8 months. Outcome measurements were made at two time points: before training and at end of training.
12 patients in the study High Resolution Manometry (HRM).
All patients in the study:
- self-assessed scoring test (using Visual Analogue Scale – VAS),
- oral sensory test,
- pharyngeal sling force (using Lip Force meter) – lower normal value ≥ 15 N,
- swallowing ability (using Timed Water Swallow Test – TWST) – lower normal value for swallowing rate ≥ 10 ml / sec,
- Velum Closure Test (VCT) – lower normal value ≥ 10 sec,
- Orofacial Motor Test,
- Orofacial Sensory Test
- Hiatal hernia symptom questionnaire.
All Orofacial motor tests and Orofacial sensory test scores were normal before treatment, indicating that there was no neurological cause to the patient’s symptoms.
- Reflux symptoms were reported before training in 100 % of patients, 100 % of these showed improvement at end of training, (p < 0.001) and 61 % were entirely symptom free and ceased PPI medication.
- All hiatal hernia patients were improved after training (p < 0.001) with IQoro and showed significant improvements in
- misdirected swallowing,
- esophageal retention,
- globus sensation,
- scores for VAS, pharyngeal sling force, VCT and TWST.
- Traction during the training action with IQoro resulted in a 65 mm Hg increase in the mean pressure of the Diaphragmatic Hiatus as measured by high resolution manometry.
Statistical significance of result
(p < 0.001) improvements in misdirected swallowing, cough, hoarseness, esophageal retention, globus sensation, VAS scores, pharyngeal sling force, velum closure and swallowing ability.
IQoro training significantly improves all the symptoms of hiatus hernia, potentially through improved hiatal competence. All symptoms were significantly improved at end of training suggesting that lasting improved hiatal competence had been achieved.