Dysphagia

Neopharyngeal diverticulum

August 27, 2014     Rebecca J. Howell, MD; Gregory N. Postma, MD
article

Endoscopic examination showed no distal stricture or cricopharyngeus muscle.

Madelung disease: Multiple symmetric lipomatosis

March 18, 2014     Enrique Palacios, MD, FACR; Harold R. Neitzschman, MD, FACR; Jeremy Nguyen, MD
article

Patients with multiple symmetric lipomatosis commonly also suffer from various neuropathies, especially paresthesias and autonomic neuropathy.

Lung herniation: An unusual cause of dysphagia

December 20, 2013     Karen Mason, MBBS, MRCS, FRCR; Richard D. Riordan, MBBS, BSC, MRCP, FRCR
article

Abstract

Lung herniation is a rare condition that can be classified on the basis of location and etiology. We report an unusual case of right apical lung herniation presenting with dysphagia. Computed tomography of the neck demonstrated an air-containing structure in the root of the right side of the neck, related to but separate from the anteromedial aspect of the right lung apex. The diagnosis of an apical lung hernia was confirmed using high-resolution CT reconstructions. This case highlights that, although uncommon, apical lung hernias should always be considered when investigating abnormalities of swallowing. Identification of an apical lung hernia on plain chest radiographs avoids further unnecessary investigations and surgical intervention. Knowledge of their presentation may avoid complications that could arise from neck interventions such as subclavian central catheter insertion.

Autoimmune swallowing disorders

December 20, 2013     Mursalin M. Anis, MD, PhD; Ahmed M.S. Soliman, MD
article

Esophageal perforation in a patient with diverticulum following anterior discectomy and fusion

October 23, 2013     Aasif A. Kazi, PharmD; Nancy L. Solowski, MD; Gregory N. Postma, MD; Paul M. Weinberger, MD
article

 Most perforations are thought to result from esophageal retraction, direct injury during manipulation, hardware failure, or movement of cervical vertebral bodies during hyperextension.

Late-onset complications after chemoradiation for head and neck carcinomas

August 21, 2013     Marc I. Surkin, MD, FACS; Sandra A. Schwartz, MS, CCC-SLP; and Deborah A. Markiewicz, MD
article

Abstract

Acute complications from chemoradiation for head and neck cancers are relatively common. These can be minor or severe and can have a significant impact on the patient's quality of life. The incidence of late-onset (>5 years after cancer cure) complications is unknown, but the effect on quality of life is just as severe as with acute problems. What makes matters worse is that many of these patients lived years without dysphagia or other issues and were able to resume a normal lifestyle before developing complications. We present 4 cases involving patients with late-onset complications and discuss the need to remain vigilant in follow-up and caring for patients with head and neck cancer.

Systemic sclerosis and reflux

April 17, 2013     John J. Petronovich, BS; Jonathan M. Bock, MD
article

MII-pH testing with impedance-based symptom association may improve diagnostic accuracy in patients with systemic sclerosis and reflux.

Esophageal graft-versus-host disease

February 25, 2013     Jeanne L. Hatcher, MD; S. Carter Wright, MD; Catherine Rees Lintzenich, MD, FACS
article

Graft-versus-host disease occurs after allogeneic hematopoietic-cell transplantation, with the chronic form usually occurring within the first 3 years.

Hyperplastic epiglottis caused by chronic inflammation

January 24, 2013     Mark D. Wilkie, MBChB; Samuel C. Leong, MPhil; Alessandro Panarese, FRCS; Arnab Banerjee, FRCS
article

Due to the development of Hib vaccines, the epidemiology of epiglottitis has shifted dramatically back toward adult presentations, with a marked decline in the incidence among children.

Hypoglossal nerve tumor: A rare primary extracranial meningioma of the neck

October 31, 2012     Abu Bakar Zulkiflee, MS; Narayanan Prepageran, FRCS; Omar Rahmat, MS; Pailoor Jayalaskhmi, MPath, FRCPath; Tengku Sharizal, MS
article

Abstract

We report a case of primary extracranial meningioma arising from the hypoglossal nerve in a 54-year-old man who presented with a 9-month history of hoarseness and progressive dysphagia. He had also noticed that his tongue was deviated to the left and, as a result, he was having difficulty pronouncing words. Examination revealed fasciculation and muscle wasting on the left side of the tongue. Other cranial nerve functions were normal. Contrast-enhanced computed tomography detected a heterogeneous mass that had arisen above the bifurcation of the left common carotid artery and had extended to near the skull base. Transcervical excision of the tumor was performed, and histopathology identified it as a meningioma of the hypoglossal nerve. The patient recovered uneventfully, and he was without recurrence at more than 2 years of follow-up. A primary extracranial meningioma is extremely rare, and its presentation may be subtle. A thorough investigation is necessary to avoid fatal compressive symptoms.

Dysphagia after strangulation

September 7, 2012     Jenna Briddell, MD; Andrew Mallon, DO; Rima A. DeFatta, MD; Farhad Chowdhury, DO; Matthew Nagorsky, MD, FACS
article

Patients with an isolated cornu fracture can be asymptomatic in the acute setting, only to develop symptoms of chronic odynophagia and globus sensation months after the inciting injury.

The effect of chronic obstructive pulmonary disease on laryngopharyngeal sensitivity

September 7, 2012     Nicola A. Clayton, MScMed, BAppSc; Giselle D. Carnaby-Mann, MPH, PhD; Matthew J. Peters, MD; Alvin J. Ing, MBBS, MD
article

Abstract

Patients with chronic obstructive pulmonary disease (COPD) may be at increased risk of aspiration secondary to impaired swallow function. One possible cause of this impairment is a reduction in laryngopharyngeal sensitivity. The relationship between COPD and laryngopharyngeal sensitivity has not been previously determined. We conducted a study to investigate the effect of COPD on laryngopharyngeal sensitivity by using laryngopharyngeal sensory discrimination testing (LPSDT). Our study population was made up of 20 adults (mean age: 71.7 yr) with clinically proven COPD and 11 healthy, age-matched controls. All 31 subjects underwent LPSDT with the use of an air-pulse stimulator via a nasendoscope. The threshold of laryngopharyngeal sensation was evaluated by measuring the amount of air pressure required to elicit the laryngeal adductor reflex (LAR). We found that the patients with COPD had a significantly higher LAR threshold than did the controls (p< 0.001). We conclude that patients with COPD have significantly less mechanosensitivity in the laryngopharynx. This sensory change may place patients with COPD at increased risk for aspiration.

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