Bilateral Vocal Fold Motion Impairment Associated With Diffuse Idiopathic Skeletal Hyperostosis

Area of Science:

• Otolaryngology
• Neurology
• Rheumatology

Background:

• Diffuse idiopathic skeletal hyperostosis (DISH) is a condition characterized by widespread calcification and ossification of ligaments and entheses.
• Bilateral vocal fold motion impairment (BVFMI) is a rare but potentially serious complication of DISH, particularly when it affects the cervical spine.
• Symptomatic BVFMI can lead to significant morbidity, including dyspnea, dysphonia, and dysphagia.

Purpose of the Study:

• To describe the clinical characteristics, interventions, and outcomes of patients with symptomatic BVFMI attributed to DISH.
• To review the current literature on DISH-related BVFMI and its management.

Main Methods:

• Retrospective cohort study of patients with symptomatic BVFMI secondary to DISH.
• Chart review and literature search conducted between February 2021 and March 2023.
• Analysis of patient demographics, symptoms, comorbidities, interventions, and outcomes.

Main Results:

• Four male patients with cervical spine DISH and symptomatic BVFMI were identified.
• Symptoms ranged from life-threatening dyspnea to breathy dysphonia and dysphagia.
• Two patients underwent osteophyte removal with improved vocal fold mobility and voice quality; two opted for observation.
• Literature review revealed a male predominance, average age of 70, and common comorbidities like hypertension and diabetes.

Conclusions:

• Both surgical and conservative interventions can provide symptomatic relief and improve vocal fold mobility in DISH-related BVFMI.
• Management should be individualized based on symptom severity and patient preference.
• Further research is needed to elucidate the etiology and optimize treatment strategies for this rare condition.