A decade of unexplained dysphagia

by Christopher Burgess, BM, BCh, Richard Hughes, MRCS, Stewart Griffiths, FRCS (SN), and Thomas Cadoux-Hudson, FRCS (SN) | Monday, June 01, 2009

A 72-year-old man was referred to the Department of Neurosurgery at the John Radcliffe Hospital for surgical management of dysphagia, the underlying cause of which had eluded diagnosis for almost 10 years. At his initial presentation nearly a decade earlier, he had reported symptoms of high dysphagia for solid foods and episodes of coughing and choking during meals. Findings on the physical examination at that time were normal, and a barium swallow test detected no obvious abnormality. A provisional diagnosis of mild neuromuscular incoordination of the pharynx was made.Over a number of years, the patient's symptoms progressed. A videofluoroscopic swallow examination demonstrated a delayed and inconsistent cough reflex, evidence of silent aspiration, and pooling of secretions in the valleculae and piriform sinuses. In the cervical spine, an x-ray showed large anterior osteophytes at C2 and C3 (figure 1, A). These osteophytes were found to interrupt bolus flow and impede the action of .../continued/

ENT Journal provides full text articles to our registered members, please log in below or sign up for a FREE membership to view the full content.
Member Login	Register as a Member