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Inflammatory myopathy causing pharyngeal dysphagia: a new entity
J Shapiro1, S Martin, U DeGirolami
1Department of Otology and Laryngology, Harvard Medical School, Beth Israel Hospital, Boston, Massachusetts, USA.
Summary
This study identifies a new cause of swallowing difficulty in older adults, characterized by muscle changes in the throat and specific videofluoroscopy findings. It highlights a distinct clinical entity of pharyngeal dysphagia.
Area of Science:
- Otolaryngology
- Neurology
- Gastroenterology
Background:
- Dysphagia, or difficulty swallowing, is a common complaint, particularly in the elderly.
- Neurological and structural causes are often investigated, but some cases remain unexplained.
Purpose of the Study:
- To describe a distinct clinical entity of isolated pharyngeal dysphagia in elderly patients.
- To characterize the unique videofluoroscopic and pathological findings associated with this condition.
Main Methods:
- Case series of seven elderly patients presenting with solid food dysphagia.
- Comprehensive evaluation including neurologic assessment, electromyography, nerve conduction studies, fiberoptic laryngoscopy, and videofluoroscopy.
- Muscle biopsies of the omohyoid and cricopharyngeus muscles were performed in some patients.
Main Results:
- Patients exhibited normal neurological evaluations and tests.
- Fiberoptic laryngoscopy revealed saliva pooling in pharyngeal recesses.
- Videofluoroscopy showed prominent cricopharyngeus muscle, decreased epiglottic tilt, and pharyngeal residue.
- Muscle biopsies indicated inflammatory myopathy without inclusion bodies.
Conclusions:
- A distinct clinical entity of isolated pharyngeal dysphagia in the elderly is identified.
- This condition is characterized by specific videofluoroscopic findings and an underlying pharyngeal myopathy.
- Pharyngoesophageal sphincter myotomy was performed in three patients, suggesting a potential therapeutic approach.