Bilateral vocal fold paralysis and dysphagia secondary to diffuse idiopathic skeletal hyperostosis

Allensworth, Jordan J.; O’Dell, Karla; Schindler, Joshua S.

doi:10.1002/hed.24569

Cited by 13 publications

(7 citation statements)

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“…Furthermore a chondritis could occur with subsequent involvement of the arytenoids and ankylosis of the cricoarytenoid joint, which is likely to be the reason why the vocal cord immobilisation of our patient did not improve ( 8 ). Another possible reason could be an infection of the recurrent nerve itself ( 10 , 19 ). We could exclude this in our patient because the intraoperative electromyography of the vocal muscle on both sides showed normal action potentials ( 20 ).…”

Section: Discussionmentioning

confidence: 99%

Cervical Hyperostosis Leading to Dyspnea, Aspiration and Dysphagia: Strategies to Improve Patient Management

2018

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Diffuse idiopathic skeletal hyperostosis (DISH) is a rare but well known cause of dysphagia. In very few cases aspiration and dyspnea are described as a clinical manifestation. An 82-year-old man presented himself in our clinic with severe dyspnea, aspiration, and pneumonia. After performing a microlaryngoscopy an emergency tracheotomy became necessary.In laryngoscopy a severe bulging of the posterior oropharyngeal and hypopharyngeal wall was detected. The glottis area was not observable and immobilisation of the right vocal cord could be detected. The CT showed anterior osteophytes and ossification of the anterior longitudinal ligament from C2–C7. We performed a panendoscopy in order to explore the upper aerodigestive area. Postoperatively an emergency tracheotomy was needed due to the development of laryngeal edema. The osteophytes were removed in cooperation with the department of orthopaedics. Three months postoperative the patient had no dyspnea or dysphagia, so the tracheotomy could be closed.Cervical hyperostosis is commonly described in elderly patients and usually presenting without symptoms, therefore a surgical treatment is usually not necessary. Nevertheless it can lead to severe morbidity and dyspnea with airway obstruction. Therefore it is essential that cervical hyperostosis is recognized early enough and appropriate treatment is initiated. Flexible endoscopy should be preferred over direct panendoscopy because it could lead to life-threatening edema and a prophylactic tracheostomy should be strongly considered in patients that present with severe dyspnea,

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Section: Discussionmentioning

confidence: 99%

Cervical Hyperostosis Leading to Dyspnea, Aspiration and Dysphagia: Strategies to Improve Patient Management

2018

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“…Combinations of dysphagia and respiratory distress are observed less frequently and it may be due to the excessive ossifications or more extensive compressions that develop. [32][33][34][35][36][37][38][39] If the corresponding osteophyte is larger on one side it may result in a distortion of the upper aero-digestive corridors with an accompanying aggravation of the preexisting symptoms. [32][33][34][35][36][37][38][39] Respiratory discomfort develops in a faster and more prominent fashion when a distortion is present 32 Retrocricoid inflammation may also induce laryngeal edema, dysphonia, vocal cord immobility, and stridor.…”

Section: Discussionmentioning

confidence: 99%

“…[32][33][34][35][36][37][38][39] If the corresponding osteophyte is larger on one side it may result in a distortion of the upper aero-digestive corridors with an accompanying aggravation of the preexisting symptoms. [32][33][34][35][36][37][38][39] Respiratory discomfort develops in a faster and more prominent fashion when a distortion is present 32 Retrocricoid inflammation may also induce laryngeal edema, dysphonia, vocal cord immobility, and stridor. [30][31][32][33][34][35][36][37][38][39] With an impingement of the esophagus, it is rare to observe the concomitant compression of the recurrent laryngeal nerve on the left side that is secondary to spiky spur formations.…”

Section: Discussionmentioning

confidence: 99%

“…[32][33][34][35][36][37][38][39] Respiratory discomfort develops in a faster and more prominent fashion when a distortion is present 32 Retrocricoid inflammation may also induce laryngeal edema, dysphonia, vocal cord immobility, and stridor. [30][31][32][33][34][35][36][37][38][39] With an impingement of the esophagus, it is rare to observe the concomitant compression of the recurrent laryngeal nerve on the left side that is secondary to spiky spur formations. This too may cause vocal cord paralysis.…”

Section: Discussionmentioning

confidence: 99%

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Two Cases Report of Dysphagia Due to Diffuse Idiopathic Skeletal Hyperostosis (DISH)

Rahimizadeh¹,

Soufiani²,

Rahimizadeh³

et al. 2018

Orthop Res Traumatol Open J

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Copyright 2018 by Rahimizadeh A. This is an open-access article distributed under Creative Commons Attribution 4.0 International License (CC BY 4.0), which allows to copy, redistribute, remix, transform, and reproduce in any medium or format, even commercially, provided the original work is properly cited.cc Case SeriesDiffuse idiopathic skeletal hyperostosis (DISH) is a common disorder among the elderly. It is a well-defined syndrome with axial and peripheral skeletal manifestations including hyperostosis at the tendon insertions site around the joint capsules as well as the ossification of the anterior longitudinal ligament (ALL) of the spine. The bridged ossified anterior longitudinal ligament may infrequently cause swallowing difficulties and respiratory distress. The initial complication is due to excessively enlarged cervical osteophytes at the cervical-subaxial level and at or below C4 with a compression of esophagus. The subsequent complications are usually secondary to enlarged spurs above C4. In this paper we discuss two cases where the patients have experienced progressive dysphagia for one year and in which radiological findings were compatible with DISH from C2-C7 with the largest existing at C4. Surgical excision of the prominent osteophytes resulted in improvement of the dysphagia in both cases.

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“…This can include tracheostomy and gastric tube placement for nutritional support or osteophytectomy which is considered to be highly successful when conservative methods fail [ 22 , 23 ]. Several authors have reported cases of dysphagia including one with bilateral vocal fold paralysis secondary to DISH where tracheotomy and cervical osteophytectomy have successfully been performed, reporting marked improvement in swallowing function and speaking ability [ 14 , 23 – 25 ]. However, recognizing the limited data regarding this condition, studies assessing the efficacy of both strategies to treat dysphagia and/or airway obstruction in the presence of DISH are lacking.…”

Section: Discussionmentioning

confidence: 99%

Diffuse Idiopathic Skeletal Hyperostosis: Persistent Sore Throat and Dysphagia in an Elderly Smoker Male

Goico-Alburquerque

Zulfiqar

Antoine

et al. 2017

Case Reports in Medicine

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Diffuse idiopathic skeletal hyperostosis (DISH) is rarely symptomatic. However, it can present with dyspnea, hoarseness, dysphagia, and stridor. An 80-year-old chronic smoker male presented with 6-month history of sore throat and progressive dysphagia. Computed tomography of the neck revealed bulky anterior bridging syndesmophytes along the anterior aspect of the cervical spine and facet effusion involving four contiguous vertebrae consistent with DISH. Dysphagia secondary to DISH was diagnosed. Fiberoptic laryngoscopy showed bilateral vocal cord paralysis. Patient's airway became compromised requiring tracheostomy tube placement. After discussion of therapeutic options, patient agreed on a percutaneous endoscopic gastrostomy tube insertion for nutritional support. Osteophytectomy was left to be discussed further.

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Bilateral vocal fold paralysis and dysphagia secondary to diffuse idiopathic skeletal hyperostosis

Abstract: In the case presented, cervical osteophytectomy dramatically reversed bilateral vocal fold paralysis and dysphagia secondary to hyperostosis, thus negating the need for prolonged tracheostomy and feeding tube dependence. © 2016 Wiley Periodicals, Inc. Head Neck 39: E1-E3, 2017.

Cited by 13 publications

References 11 publications

Cervical Hyperostosis Leading to Dyspnea, Aspiration and Dysphagia: Strategies to Improve Patient Management

Cervical Hyperostosis Leading to Dyspnea, Aspiration and Dysphagia: Strategies to Improve Patient Management

Two Cases Report of Dysphagia Due to Diffuse Idiopathic Skeletal Hyperostosis (DISH)

Diffuse Idiopathic Skeletal Hyperostosis: Persistent Sore Throat and Dysphagia in an Elderly Smoker Male

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