Stridor and dysphagia in diffuse idiopathic skeletal hyperostosis (DISH)

Area of Science:

• Otolaryngology
• Rheumatology
• Neurosurgery

Background:

• Diffuse idiopathic skeletal hyperostosis (DISH) is a non-inflammatory skeletal disorder characterized by ossification of ligaments and entheses.
• Otolaryngologists frequently encounter patients with stridor and dysphagia, necessitating a broad differential diagnosis.
• Extrinsic and intrinsic etiologies must be considered for these common presenting symptoms.

Observation:

• A series of patients with DISH presented with significant stridor or dysphagia.
• Clinical presentation, physical examination findings, and radiographic evidence of cervical spine involvement were documented.
• The severity of symptoms correlated with the extent of DISH in the cervical spine.

Findings:

• Surgical intervention was considered and performed in select cases of DISH causing severe stridor or dysphagia.
• Surgical outcomes were reviewed, challenging the traditional view that surgery is rarely indicated.
• Management strategies included decompression and stabilization of the cervical spine.

Implications:

• Surgical management may be a viable option for carefully selected patients with DISH-induced airway or swallowing compromise.
• This study contributes to understanding the otolaryngologic manifestations of DISH.
• Further research is warranted to establish definitive surgical guidelines for DISH affecting the cervical spine.