# Use of Pinching Nose Maneuver in a Patient With Severe Dysphagia Caused by Pseudobulbar Palsy

## TL;DR

A new technique called the pinching nose maneuver helps patients with severe swallowing issues caused by pseudobulbar palsy.

## Contribution

The pinching nose maneuver is introduced as a novel method to aid swallowing in patients with cognitive dysfunction.

## Key findings

- Pinching the nose opened the fauces and relieved functional obstruction during swallowing.
- The maneuver enabled bolus flow into the pharyngeal cavity and esophagus in a patient with severe cognitive impairment.
- The technique shows potential for improving swallowing in patients with pseudobulbar palsy.

## Abstract

Swallowing disorders resulting from pseudobulbar palsy are characterized by deficiencies in the oral preparatory and oral stages of the swallowing process. In certain cases, obstruction can occur when the tongue base comes into contact with the palate, impeding the intraoral bolus flow into the pharyngeal cavity. In this report, we discuss a case of severe pseudobulbar palsy, in which an intraoral bolus flowed into the pharyngeal cavity with pinching the nose. A 78-year-old man with a history of recurrent cerebral infarction was evaluated. The patient had severe dysphagia and cognitive impairment due to pseudobulbar palsy. A videofluoroscopic examination of swallowing (VF) was conducted while the patient was in a reclined position. In the oral cavity, when the bolus reached the posterior tongue section, the flow was hindered by the functional obstruction caused by the tongue base pressing against the palate. Despite the clinician’s instructions to swallow, the patient was unable to comply due to the severity of his cognitive impairment. To alleviate this obstruction, the clinician pinched the patient’s nose. This action opened the fauces, facilitating breathing and relieving the functional obstruction. Subsequently, the bolus flowed into the pharyngeal cavity and successfully flowed into the esophagus while swallowing. This maneuver was named the “pinching nose maneuver” (PNM). The PNM, as described here, can serve as a technique to improve the movement of an intraoral bolus into the pharyngeal cavity in patients with cognitive dysfunction.