Ultrasound-guided Fire Needle Acupuncture For Treating Sialorrhea In Tracheotomized Patients
June 12th, 2026
Here, we present a protocol to apply fire needling under ultrasound guidance to the glandular or muscular layers for the treatment of sialorrhea in poststroke tracheotomized patients.
This study aim to reduce salivary secretion in poststroke tracheostomy patients to lens, care burden and aspiration risk. This protocol apply to patients with abdominal gland secretion caused by various central nervous system injury. To begin, set up the treatment environment and prepare the patient for the procedure.
Then turn on the ultrasound system and press the start/end button to initiate the examination. Press the probe button and select the L154 linear array transducer. Press the patient button and enter the patient's name.
Then select the color doppler mode. Localize the acupoints on one side of the face sequentially as Xiaguan, Yifeng, and the inferior Jiache point. Place the ultrasound transducer transversely with the probe marker positioned at Xiaguan.
Move the ultrasound transducer horizontally to identify the local vascular course under ultrasound imaging. Define the needle insertion points on the skin surface at Xiaguan and 0.5 centimeters lateral to it on both sides horizontally. Select an appropriate needling depth to target the masseter muscle layer while avoiding blood vessels.
Press the measurement button to measure the needling depth range and record the needling depth. Next, place the ultrasound transducer longitudinally with the probe marker positioned at Yifeng. Move the ultrasound transducer vertically to identify the local vascular course under ultrasound imaging.
Define the needle insertion points on the skin surface at Yifeng and 0.5 centimeters superior and inferior to it vertically. Determine an appropriate needle insertion depth that effectively targets the parotid gland layer while minimizing the risk of vascular injury. Then use the measurement function to assess the depth range and document the selected needling depth.
Place the ultrasound transducer transversely with the probe marker positioned at the inferior Jiache point. Move the ultrasound transducer horizontally to identify the local vascular course under ultrasound imaging. Identify the needle insertion points on the skin surface at the inferior Jiache point and 0.5 centimeters laterally from it on both sides.
Select a suitable depth for needle insertion to access the submandibular gland while carefully avoiding adjacent blood vessels. Afterwards, utilize the measurement function to assess the range of depths. Document the selected needling depth.
Similarly, localize the acupoints on the contralateral side. Perform preoperative disinfection using medical alcohol. Now heat the tip of the fire needle in the outer flame of an alcohol lamp until it glows from red to white hot.
Rapidly and perpendicularly insert it into the acupoint and the surrounding needling points to the predetermined depth. After pricking, press the needle hole with a clean, dry cotton ball to prevent infection. Perform needling on the opposite side of the face and mandible using the same method.
Finally, assess the patient's sialorrhea status before and after treatment using the drooling severity and frequency scale, or DSFS. Before treatment, DSFS scores showed no significant difference between the control group and the experimental group. After treatment, the DSFS scores in the experimental group were significantly lower than those in the control group.
There was no significant difference in unstimulated salivary flow rate between the control and experimental groups before treatment. Following treatment, however, the unstimulated salivary flow rate in the experimental group was significantly lower than that in the control group. Prior to treatment, the one-hour subglottic secretion aspirate volume showed no significant difference between the control and experimental groups.
After treatment, the experimental group demonstrated a significantly lower one-hour subglottic secretion aspirate volume compared to the control group. This protocol allows researchers to study fire needle effects on gland secretion, sialorrhea frequency and subglottic sialorrhea volume. The key challenge is precise, safe fire needling per patient.
We solved this with pre-needling ultrasound localization. Future studies should extend duration, assess durability, decannulation risk and stratified skin reactions.
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Overview
Sialorrhea, or excessive saliva overflow, is a frequent complication in stroke patients, often leading to physical discomfort and psychosocial issues. Traditional pharmacological treatments have limited efficacy and notable side effects. This article introduces an ultrasound-guided fire needling technique as a non-pharmacological alternative for managing sialorrhea, aiming to improve precision and minimize adverse effects.
Key Study Components
Area of Science
- Neurology
- Traditional Chinese Medicine
- Rehabilitation Medicine
Background
- Sialorrhea results from excessive saliva production or impaired swallowing.
- It is common after stroke and can cause inflammation, aspiration pneumonia, and increased healthcare costs.
- Standard treatments include anticholinergic drugs and botulinum toxin, but these have limited effectiveness and side effects like dry mouth and worsened swallowing.
- Non-pharmacological therapies, such as acupuncture and rehabilitation, are being explored for better outcomes.
Purpose of Study
- To develop and describe an ultrasound-guided fire needling method for sialorrhea management.
- To reduce salivary volume and frequency of salivation in patients unresponsive to medication.
- To enhance treatment precision and safety by visualizing target tissues preoperatively.
Methods Used
- Application of fire needling, a traditional Chinese medicine technique combining needle stimulation and thermal effects.
- Use of ultrasound guidance to visualize muscular and glandular structures before needle insertion.
- Precise targeting of glandular or muscular layers to optimize efficacy and minimize complications.
- Rapid procedure with no needle retention and only transient pain.
Main Results
- Ultrasound guidance enables accurate localization of target tissues.
- Fire needling reduces both the volume and frequency of salivation.
- The technique avoids common side effects associated with pharmacological treatments.
- Improved safety and efficacy for patients with poor response to standard therapies.
Conclusions
- Ultrasound-guided fire needling is a promising non-pharmacological option for sialorrhea management.
- It offers precise, safe, and effective reduction of excessive salivation.
- This approach may benefit stroke patients and others with refractory sialorrhea.
Frequently Asked Questions
Executive Industry Relevance
Managing sialorrhea in tracheotomized and post-stroke patients remains a significant challenge due to limited efficacy and adverse effects of standard pharmacological interventions. Ultrasound-guided fire needle acupuncture offers a non-pharmacological, precision-based approach that may reduce salivary volume and frequency while minimizing complications. This technique supports portfolio diversification in neurology and rehabilitation pipelines by addressing unmet needs in refractory patient populations.
Strategic Applications in Biopharma R&D
Early Discovery & Target Validation
- Enables interrogation of neuromuscular and glandular pathways involved in sialorrhea.
- Supports biological de-risking by providing a non-drug intervention for difficult-to-treat cases.
- Facilitates functional validation of targeted tissue modulation using real-time imaging.
Screening & Assay Development
- Establishes a reproducible, image-guided protocol for evaluating intervention efficacy.
- Standardizes treatment delivery through ultrasound visualization, supporting quantitative outcome measurement.
- Prepares a validated procedural framework for downstream comparative studies of non-pharmacological therapies.
Translational & Preclinical Research
- Aligns with translational goals by bridging traditional techniques and modern imaging for enhanced safety and precision.
- Provides a platform for preclinical modeling of salivary gland modulation in neurological disorders.
- Enables risk-adjusted advancement of non-drug therapies for complex patient cohorts.
Pipeline & Workflow Integration
This ultrasound-guided intervention fits within the continuum from early discovery of neuromodulatory targets to translational research on non-pharmacological therapies for sialorrhea.
- Discovery Biology: Supports hypothesis testing on glandular and muscular contributions to sialorrhea.
- Screening: Delivers reproducible, quantitative assessment of salivary output post-intervention.
- Analytics: Enables measurement of treatment precision and safety via imaging and clinical endpoints.
- Translational Research: Facilitates continuity from procedural innovation to patient-centered outcome studies.
- Enterprise Reuse: Provides a scalable, image-guided protocol adaptable to other neuromuscular or glandular disorders.
Operational & Enterprise Impact
- Scientific Value: Increases predictive confidence in non-pharmacological modulation of salivary function.
- Operational Value: Enhances standardization and reproducibility through ultrasound guidance.
- Strategic Value: Reduces reliance on pharmacological agents with adverse effects, supporting safer patient management.
- Portfolio Impact: Expands therapeutic options for refractory sialorrhea, informing risk-adjusted advancement decisions.
Implementation Considerations
- Requires expertise in ultrasound imaging and fire needle acupuncture techniques.
- Demands access to high-resolution ultrasound equipment for procedural accuracy.
- Necessitates cross-team training to ensure protocol standardization and reproducibility.
- May require adaptation for anatomical variability across patient populations.
- Limited by the need for specialized skills and equipment in non-pharmacological intervention settings.
