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Diffuse idiopathic skeletal hyperostosis causing obstructing laryngeal edema

B Marks1, E Schober, H Swoboda

  • 1Department of Otorhinolaryngology, Head and Neck Surgery, University of Vienna, Austria.

European Archives of Oto-Rhino-Laryngology : Official Journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : Affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery
|June 25, 1998
PubMed
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Diffuse idiopathic skeletal hyperostosis (DISH) can cause severe breathing problems due to cervical osteophytes. Surgical removal of these bone spurs relieved symptoms in a reported case.

Area of Science:

  • Rheumatology
  • Radiology
  • Otolaryngology

Background:

  • Diffuse idiopathic skeletal hyperostosis (DISH), also known as Forestier's disease, is a skeletal ossification disorder of unknown cause.
  • Radiographic diagnosis involves identifying osseous bridging of four or more vertebrae, a radiolucent line, large osteophytes, and preserved disk height.

Observation:

  • While common in autopsies (6-12%), DISH rarely presents with significant clinical symptoms.
  • A patient with DISH developed severe dyspnea due to laryngeal inlet edema caused by enlarged cervical osteophytes.

Findings:

  • The cervical osteophytes in this DISH case led to airway compromise requiring emergency tracheotomy.
  • Surgical excision of the osteophytic masses effectively resolved the patient's respiratory symptoms.

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Implications:

  • This case highlights that DISH, though often asymptomatic, can present with severe, life-threatening complications.
  • Management of symptomatic DISH depends on the specific clinical presentation, with surgical intervention being a viable option for severe osteophyte-induced issues.