A Bump in the Road: An Uncommon Cause of Dysphagia

Excerpt

A 28-year-old Caucasian female consulted the otorhinolaryngologist with a history of tinnitus since two months and a sensation of bilateral intra-aural pressure, as well as a strangulating feeling and sensation of pressure localized to the throat. The patient was under the impression that ingested liquids were partially retained in her esophagus, a problem which had been present longer than her otologic symptoms. She only sporadically experienced discomfort on ingesting solid food. Her further clinical history was unremarkable. The family history showed Alport’s syndrome. Her medical history revealed an episode of transient abducens nerve palsy 20 years earlier, a gastric bypass procedure, and a subsequent laparoscopic internal hernia reduction, as well as an episode of tonsillitis requiring hospitalization for intravenous antibiotics several years before the current presentation. The physical exam of the oral and pharyngeal cavity showed minor edema between the arytenoid processes, but no other abnormalities. An otoscopic exam and audiometry were normal. An MRI of the brain and inner ear was requested to exclude vestibulocochlear nerve pathology and endolymphatic hydrops, but could not elucidate any abnormalities. An ultrasound exam of the neck excluded thyroid and other cervical abnormalities. Then a fluoroscopic barium swallow was ordered to investigate the sensation of esophageal liquid retention, more specifically to prove stasis and exclude external compression. This study showed a normal oral and pharyngeal swallowing function. Pertinent images of the esophageal phase of the study are shown in Fig. 1.

…