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DYSPHAGIA ASSESSMENT AND TREATMENT PLANNING: A TEAM APPROACH
Neck Surgery, 126(6), 649–652. https://
doi.org/10.1067/mhn.2002.125603
Belafsky, P. C., Postma, G. N., & Koufman,
J. A. (2002b). Validity and reliability of
the Reflux Symptom Index (RSI). Journal
of Voice, 16(2), 274–277. https://doi.org/
10.1016/s0892-1997(02)00097-8
Book, D. T., Rhee, J. S., Toohill, R. J., &
Smith, T. L. (2002). Perspectives in laryngopharyngeal reflux: An international
survey. Laryngoscope, 112(8, Pt. 1), 1399–
1406. https://doi.org/10.1097/00005537200208000-00014
Carroll, A. E. (2017). The high costs of unnec-
essary care. JAMA, 318(18), 1748. https://
doi.org/10.1001/jama.2017.16193
Carroll, T. L., Werner, A., Nahikian, K.,
Dezube, A., & Roth, D. F. (2017). Rethinking the laryngopharyngeal reflux treatment algorithm: Evaluating an alternate
empiric dosing regimen and considering
up-front, pH-impedance, and manometry testing to minimize cost in treating
suspect laryngopharyngeal reflux disease. Laryngoscope, 127(Suppl. 6), S1–S13.
https://doi.org/10.1002/lary.26806
Celik, M., Alkan, Z., Ercan, I., Ertasoglu, H.,
Alkm, C., Erdem, L., . . . Ertekin, C.
(2005). Cricopharyngeal muscle electromyography in laryngopharyngeal reflux.
Laryngoscope, 115(1), 138–142. https://
doi.org/10.1097/01.mlg.0000150690 .85
387.76
Cherry, J., & Margulies, S. I. (1968). Contact
ulcer of the larynx. Laryngoscope, 78(11),
1937–1940. https://doi.org/10.1288/0000
5537-196811000-00007
Cohen, J. T., Bach, K. K., Postma, G. N., &
Koufman, J. A. (2002). Clinical manifestations of laryngopharyngeal reflux. Ear,
Nose, & Throat Journal, 81(9, Suppl. 2),
19–23.
Delahunty, J. E., & Cherry, J. (1968). Experi-
mentally produced vocal cord granulomas. Laryngoscope, 78(11), 1941–1947.
https://doi.org/10.1288/00005537196811000-00008
DelGaudio, J. M. (2005). Direct nasopha-
ryngeal reflux of gastric acid is a con-
tributing factor in refractory chronic
rhinosinusitis. Laryngoscope, 115(6), 946–
957. https://doi.org/10.1097/01.MLG.00
00163751.00885.63
Demeester, T. R., Johnson, L. F., Joseph, G.
J., Toscano, M. S., Hall, A. W., & Skinner,
D. B. (1976). Patterns of gastroesophageal reflux in health and disease. Annals
of Surgery, 184(4), 459–470. https://doi
.org/10.1097/00000658-197610000-00009
Dore, M. P., Pedroni, A., Pes, G. M., Maragk-
oudakis, E., Tadeu, V., Pirina, P., . . .
Malaty, H. M. (2007). Effect of antisecretory therapy on atypical symptoms in
gastroesophageal reflux disease. Diges-
tive Diseases and Sciences, 52(2), 463–468.
https://doi.org/10.1007/s10620-0069573-7
Fossmark, R., Martinsen, T. C., & Waldum,
H. L. (2019). Adverse effects of proton
pump inhibitors
sibility. International Journal of Molecular
Sciences, 20(20), 5203. https://doi.org/
10.3390/ijms20205203
Francis, D. O., Rymer, J. A., Slaughter, J. C.,
Choksi, Y., Jiramongkolchai, P., Ogbeide,
E., . . . Vaezi, M. F. (2013). High economic
burden of caring for patients with suspected extraesophageal reflux. American
Journal of Gastroenterology, 108(6), 905–
911. https://doi.org/10.1038/ajg.2013.69
Gerhardt, D. C., Shuck, T. J., Bordeaux, R.
A., & Winship, D. H. (1978). Human
upper esophageal sphincter. Response
to volume, osmotic, and acid stimuli.
Gastroenterology, 75(2), 268–274.
Halum, S. L., Postma, G. N., Johnston, C.,
Belafsky, P. C., & Koufman, J. A. (2005).
Patients with isolated laryngopharyngeal
reflux are not obese. Laryngoscope, 115(6),
1042–1045. https://doi.org/10.1097/01
.MLG.0000162656.05715.57
Hanson, D. G., Jiang, J., & Chi, W. (1998).
Quantitative color analysis of laryngeal
erythema in chronic posterior laryngitis.
Journal of Voice, 12(1), 78–83. https://doi
.org/10.1016/s0892-1997(98)80077-5
Harrell, S., Evans, B., Goudy, S., Winstead,
W., Lentsch, E., Koopman, J., & Wo, J. M.
— evidence and plau-
18. LARYNGOPHARYNGEAL REFLUX
https://t.me/medicina_free
435
(2005). Design and implementation of
an ambulatory pH monitoring protocol
in patients with suspected laryngopharyngeal reflux. The Laryngoscope, 115(1),
89–92. https://doi.org/10.1097/01.mlg
00150696.54000.a2
Helm, J. F., Dodds, W. J., Riedel, D. R., Tee-
ter, B. C., Hogan, W. J., & Arndorfer, R. C.
(1983). Determinants of esophageal acid
clearance in normal subjects. Gastroenter-
ology, 85(3), 607–612.
Hickson, C., Simpson, C. B., & Falcon, R.
(2001). Laryngeal pseudosulcus as a
predictor of laryngopharyngeal reflux.
Laryngoscope, 111(10), 1742–1745. https://
doi.org/10.1097/00005537-20011000000014
Jaspersen, D., Kulig, M., Labenz, J., Leo
dolter, A., Lind, T., Meyer-Sabellek, W.,
. . . Malfertheiner, P. (2003). Prevalence
of extra-oesophageal manifestations in
gastro-oesophageal reflux disease: An
analysis based on the ProGERD study.
Alimentary Pharmacology & Therapeutics,
17(12), 1515–1520. https://doi.org/ 10 .10
46/j.1365-2036.2003.01606.x
Johnston, N., Bulmer, D., Gill, G. A., Panetti,
M., Ross, P. E., Pearson, J. P., . . . Koufman,
J. A. (2003). Cell biology of laryngeal epithelial defenses in health and disease:
Further studies. Annals of Otology, Rhinol-
ogy, and Laryngology, 112(6), 481–491.
https://doi.org/10.1177/00034894031
1200601
Johnston, N., Knight, J., Dettmar, P. W.,
Lively, M. O., & Koufman, J. (2004). Pepsin and carbonic anhydrase isoenzyme
III as diagnostic markers for laryngopharyngeal reflux disease. Laryngoscope,
114(12), 2129–2134. https://doi.org/10.10
97/ 01.mlg.0000149445.07146.03
Katz, P. O., Dunbar, K. B., Schnoll-Suss-
man, F. H., Greer, K. B., Yadlapati, R.,
& Spechler, S. J. (2022). ACG clinical
guideline for the diagnosis and management of gastroesophageal reflux disease.
Official Journal of the American College of
Gastroenterology, 117(1), 27. https://doi
.org/10.14309/ajg.0000000000001538
.00
Koufman, J. A. (1991). The otolaryngologic
manifestations of gastroesophageal
reflux disease (GERD): A clinical investigation of 225 patients using ambulatory
24-hour pH monitoring and an experimental investigation of the role of acid
and pepsin in the development of laryngeal injury. The Laryngoscope, 101(4, Pt. 2,
Suppl. 53), 1–78. https://doi.org/10.10
02/ lary.1991.101.s53.1
Koufman, J. A. (1995). Gastroesophageal
reflux and voice disorders. In J. S. Rubin,
R. T. Sataloff, G. Korovin, & W. J. Gould
(Eds.), Diagnosis and treatment of voice dis-
orders (pp. 161–175). Igaku-Shoin.
Koufman, J. A. (2002). Laryngopharyngeal
reflux is different from classic gastroesophageal reflux disease. Ear, Nose, &
Throat Journal, 81(9, Suppl. 2), 7–9.
Koufman, J. A., Amin, M. R., & Panetti, M.
(2000). Prevalence of reflux in 113 consecutive patients with laryngeal and
voice disorders. Otolaryngology-Head and
Neck Surgery, 123(4), 385–388. https://
doi.org/10.1067/mhn.2000.109935
Koufman, J. A., Aviv, J. E., Casiano, R. R., &
Shaw, G. Y. (2002). Laryngopharyngeal
reflux: Position statement of the committee on speech, voice, and swallowing
disorders of the American Academy of
Otolaryngology-Head and Neck Surgery.
Otolaryngology-Head and Neck Surgery,
127(1), 32–35. https://doi.org/10.1067/
mhn .2002.125760
Koufman, J. A., Belafsky, P. C., Bach, K. K.,
Daniel, E., & Postma, G. N. (2002). Prevalence of esophagitis in patients with
pH-documented laryngopharyngeal reflux. Laryngoscope, 112(9), 1606–1609.
https://doi.org/10.1097/00005537-2002
09000-00014
Koufman, J. A., Sataloff, R. T., & Toohill, R.
(1996). Laryngopharyngeal reflux: Consensus conference report. Journal of Voice,
10(3), 215–216. https://doi.org/10.1016/
s0892-1997(96)80001-4
Lechien, J. R., Akst, L. M., Hamdan, A. L.,
Schindler, A., Karkos, P. D., Barillari,
M. R., . . . Vaezi, M. F. (2019). Evalua-
436
https://t.me/medicina_free
DYSPHAGIA ASSESSMENT AND TREATMENT PLANNING: A TEAM APPROACH
tion and management of laryngopharyngeal reflux disease: State of the art
review. Otolaryngology-Head and Neck
Surgery, 160(5), 762–782. https://doi.org/
10.1177/0194599819827488
Lechien, J. R., Saussez, S., & Karkos, P. D.
(2018). Laryngopharyngeal reflux disease: Clinical presentation, diagnosis
and therapeutic challenges in 2018. Cur-
rent Opinion in Otolaryngology & Head
and Neck Surgery, 26(6), 392. https://doi
.org/10.1097/MOO.0000000000000486
Lewin, J. S., Gillenwater, A. M., Garrett, J.
D., Bishop-Leone, J. K., Nguyen, D. D.,
Callender, D. L., . . . Myers, J. N. (2003).
Characterization of laryngopharyngeal
reflux in patients with premalignant or
early carcinomas of the larynx. Cancer,
97(4), 1010–1014. https://doi.org/10.10
02/cncr.11158
Lindstrom, D. R., Wallace, J., Loehrl, T. A.,
Merati, A. L., & Toohill, R. J. (2002). Nissen fundoplication surgery for extra
esophageal manifestations of gastroesophageal reflux (EER). Laryngoscope,
112(10), 1762–1765. https://doi.org/10.10
97/00005537-200210000-00010
Little, F. B., Koufman, J. A., Kohut, R. I., &
Marshall, R. B. (1985). Effect of gastric
acid on the pathogenesis of subglottic
stenosis. Annals of Otology, Rhinology, and
Laryngology, 94(5, Pt. 1), 516–519. https://
doi.org/10.1177/000348948509400521
Mamede, R. C., De Mello-Filho, F. V.,
Vigário, L. C., & Dantas, R. O. (2000).
Effect of gastroesophageal reflux on
hypertrophy of the base of the tongue.
Otolaryngology-Head and Neck Surgery,
122(4), 607–610. https://doi.org/10.1067/
mhn.2000.98362
Mandel, K. G., Daggy, B. P., Brodie, D. A., &
Jacoby, H. I. (2000). Review article: Alginate-raft formulations in the treatment of
heartburn and acid reflux. Alimentary
Pharmacology & Therapeutics, 14(6), 669–
690. https://doi.org/10.1046/j.1365-2036
.2000.00759.x
Maronian, N. C., Azadeh, H., Waugh, P., &
Hillel, A. (2001). Association of laryngo-
-
pharyngeal reflux disease and subglottic
stenosis. Annals of Otology, Rhinology,
and Laryngology, 110(7, Pt. 1), 606–612.
https://doi.org/10.1177/00034894011100
0703
Merati, A. L., Lim, H. J., Ulualp, S. O., &
Toohill, R. J. (2005). Meta-analysis of upper
probe measurements in normal subjects
and patients with laryngopharyngeal
reflux. Annals of Otology, Rhinology, and
Laryngology, 114(3), 177–182. https://doi
.org/10.1177/000348940511400302
Noordzij, J. P., Khidr, A., Evans, B. A., Des-
per, E., Mittal, R. K., Reibel, J. F., & Levine,
P. A. (2001). Evaluation of omeprazole
in the treatment of reflux laryngitis:
Aprospective, placebo-controlled, randomized, double-blind study. Laryn-
goscope, 111(12), 2147–2151. https://doi
.org/10.1097/00005537-200112000-00013
Orlando, R. C. (1986). Esophageal epithe-
lial resistance. Journal of Clinical Gastro-
enterology, 8(Suppl. 1), 12–16. https://
.org/10.1097/00004836-198606001-
doi
00004
Ormseth, E. J., & Wong, R. K. (1999). Reflux
laryngitis: Pathophysiology, diagnosis,
and management. The American Journal
of Gastroenterology, 94(10), 2812–2817.
https://doi.org/10.1111/j.1572-0241
.1999.1421_a.x
Park, K. H., Choi, S. M., Kwon, S. U. K.,
Yoon, S. W., & Kim, S. U. K. (2006). Diagnosis of laryngopharyngeal reflux among
globus patients. Otolaryngology-Head and
Neck Surgery, 134(1), 81–85. https://doi
.org/10.1016/j.otohns.2005.08.025
Park, W., Hicks, D. M., Khandwala, F.,
Richter, J. E., Abelson, T. I., Milstein, C.,
& Vaezi, M. F. (2005). Laryngopharyngeal reflux: Prospective cohort study
evaluating optimal dose of proton-pump
inhibitor therapy and pretherapy predictors of response. Laryngoscope, 115(7),
1230–1238. https://doi.org/10.1097/01
.MLG.0000163746.81766.45
Peghini, P. L., Katz, P. O., Bracy, N. A., &
Castell, D. O. (1998). Nocturnal recovery
of gastric acid secretion with twice-daily
18. LARYNGOPHARYNGEAL REFLUX
https://t.me/medicina_free
437
dosing of proton pump inhibitors. American Journal of Gastroenterology, 93(5),
763–767. https://doi.org/10.1111/j.1572-
0241.1998.221_a.x
Postma, G. N. (2000). Ambulatory pH mon-
itoring methodology. Annals of Otology,
Rhinology, and Laryngology, Supplement,
184, 10–14. https://doi.org/10.1177/00034
89400109s1003
Postma, G. N., Belafsky, P. C., Aviv, J. E., &
Koufman, J. A. (2002). Laryngopharyngeal reflux testing. Ear, Nose, & Throat
Journal, 81(9, Suppl. 2), 14–18.
Postma, G. N., Cohen, J. T., Belafsky, P.
C., Halum, S. L., Gupta, S. K., Bach, K.
K., & Koufman, J. A. (2005). Transnasal esophagoscopy: Revisited (over 700
consecutive cases). Laryngoscope, 115(2),
321–323. https://doi.org/10.1097/01.mlg
.0000154741.25443.fe
Postma, G. N., Johnson, L. F., & Koufman,
J. A. (2002). Treatment of laryngopharyngeal reflux. Ear, Nose, & Throat Journal,
81(9, Suppl. 2), 24–26.
Postma, G. N., Tomek, M. S., Belafsky, P.
C., & Koufman, J. A. (2001). Esophageal
motor function in laryngopharyngeal
reflux is superior to that in classic gastroesophageal reflux disease. Annals
of Otology, Rhinology, and Laryngology,
110(12), 1114–1116. https://doi.org/10.11
77/000348940111001205
Reavis, K. M., Morris, C. D., Gopal, D.
V., Hunter, J. G., & Jobe, B. A. (2004).
Laryngopharyngeal reflux symptoms
better predict the presence of esophageal adenocarcinoma than typical gastroesophageal reflux symptoms. Annals
of Surgery, 239(6), 849–856; discussion
856–858. https://doi.org/10.1097/01
.sla.0000128303.05898.ee
Reulbach, T. R., Belafsky, P. C., Blalock, P. D.,
Koufman, J. A., & Postma, G. N. (2001).
Occult laryngeal pathology in a community-based cohort. Otolaryngology-Head
and Neck Surgery, 124(4), 448–450. https://
doi.org/10.1067/mhn.2001.114256
Richardson, B. E., Heywood, B. M., Sims,
H. S., Stoner, J., & Leopold, D. A. (2004).
Laryngopharyngeal reflux: Trends in
diagnostic interpretation criteria. Dys-
phagia, 19(4), 248–255. https://doi.org/
10.1007/s00455-004-0014-5
Sasaki, C. T., Ross, D. A., & Hundal, J.
(2003). Association between Zenker
diverticulum and gastroesophageal reflux disease: Development of a working
hypothesis. American Journal of Medicine,
115(Suppl. 3A), 169S–171S. https://doi
.org/10.1016/s0002-9343(03)00218-3
Smoak, B. R., & Koufman, J. A. (2001).
Effects of gum chewing on pharyngeal
and esophageal pH. Annals of Otology,
Rhinology, and Laryngology, 110(12), 1117–
1119. https://doi.org/10.1177/00034894
0111001206
Steward, D. L., Wilson, K. M., Kelly, D. H.,
Patil, M. S., Schwartzbauer, H. R., Long,
J. D., & Welge, J. A. (2004). Proton pump
inhibitor therapy for chronic laryngopharyngitis: A randomized placebocontrol trial. Otolaryngology-Head and
Neck Surgery, 131(4), 342–350. https://
doi.org/10.1016/j.otohns.2004.03.037
Toohill, R. J., Mushtag, E., & Lehman, R. H.
(1990). Otolaryngologic manifestations
of gastroesophageal reflux. In T. Sacristan, J. J. Alvarez-Vincent, & J. Bartual
(Eds.), Proceedings of XIV World Congress
of Otolaryngology-Head and Neck Surgery
(pp. 3005–3009). Kugler & Ghedini.
Tutuian, R., & Castell, D. O. (2004). Noc-
turnal acid breakthrough — Approach
to management. MedGenMed: Medscape
General Medicine, 6(4), 11.
Ulualp, S. O., Toohill, R. J., Kern, M., &
Shaker, R. (1998). Pharyngo-UES contractile reflex in patients with posterior
laryngitis. Laryngoscope, 108(9), 1354–
1357. https://doi.org/10.1097/00005537199809000-00018
Vincent, D. A., Garrett, J. D., Radionoff,
S. L., Reussner, L. A., & Stasney, C. R.
(2000). The proximal probe in esophageal pH monitoring: Development of
a normative database. Journal of Voice,
14(2), 247–254. https://doi.org/10.1016/
s0892-1997(00)80033-8
438
https://t.me/medicina_free
DYSPHAGIA ASSESSMENT AND TREATMENT PLANNING: A TEAM APPROACH
Wang, Y., Pan, T., Wang, Q., & Guo, Z. (2009).
Additional bedtime H2-receptor antagonist for the control of nocturnal gastric
acid breakthrough. Cochrane Database of
Systematic Reviews, 4, CD004275. https://
doi.org/10.1002/14651858.CD004275
.pub3
Westcott, C. J., Hopkins, M. B., Bach, K.,
Postma, G. N., Belafsky, P. C., & Kouf
man, J. A. (2004). Fundoplication for
laryngopharyngeal reflux disease. Jour-
nal of the American College of Surgeons,
199(1), 23–30. https://doi.org/10.1016/j
.jamcollsurg.2004.03.022
Wiener, G. J., Koufman, J. A., & Wu, W. C.
(1987). The pharyngo-esophageal dual
ambulatory pH probe for evaluation of
atypical manifestations of gastroesophageal reflux (GER). Gastroenterology, 92(5),
1694.
Wiener, G. J., Koufman, J. A., Wu, W. C.,
Cooper, J. B., Richter, J. E., & Castell, D.
O. (1989). Chronic hoarseness secondary to gastroesophageal reflux disease:
Documentation with 24-h ambulatory
pH monitoring. The American Journal of
Gastroenterology, 84(12), 1503–1508.
Woo, P., Noordzij, P., & Ross, J. A. (1996).
Association of esophageal reflux and
globus symptom: Comparison of laryngoscopy and 24-hour pH manometry.
Otolaryngology-Head and Neck Surgery,
115(6), 502–507. https://doi.org/10.1016/
S0194-59989670003-7
Wright, R. C., & Rhodes, K. P. (2003).
Improvement of laryngopharyngeal re-
flux symptoms after laparoscopic Hill
repair. American Journal of Surgery, 185(5),
455–461. https://doi.org/10.1016/s00029610(03)00052-7
Ylitalo, R., Lindestad, P. A., & Ramel, S.
(2001). Symptoms, laryngeal findings,
and 24-hour pH monitoring in patients
with suspected gastroesophago-pharyngeal reflux. Laryngoscope, 111(10), 1735–
1741. https://doi.org/10.1097/00005537200110000-00013
Ylitalo, R., & Ramel, S. (2002). Gastroesoph-
agopharyngeal reflux in patients with
contact granuloma: A prospective controlled study. Annals of Otology, Rhinol-
ogy, and Laryngology, 111(2), 178–183.
https://doi.org/10.1177/00034894021
1100213
Spinal Abnormalities
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in Dysphagia
Derrick R. Randall
INTRODUCTION
The cervical spine is a feature of all
organisms belonging to the phylum
chordata and affords multiple different ranges of neck motion: flexion,
extension, rotation, lateral flexion, and
translation. In hominids and some primates, it is held in a primarily vertical
orientation responsible for maintaining
the head upright and at an appropriate plane for vision while supporting
and protecting the spinal cord along
with its spinal nerves, which affords a
number of functional advantages but
also anatomic challenges. The chronic
strain from the weight of the head and
high joint mobility cause strain on the
musculoskeletal supports and translate
to anatomic derangements over time in
many people. Deeper understanding of
the interplay of these alterations with
normal swallowing and adaptation
forms a complex and largely unanswered area of dysphagia research. The
importance of swallowing disorders
and dysphagia in the context of cervical
spine anomalies is underscored by their
frequency, and the lack of scientific
evaluation and hypothesis-based testing needed to guide recommendations
is an avenue for future research investigations. Multiple medical subspecialties and allied health fields encounter
patients with cervical anomalies, resulting in further confusion and disagreement on the contribution of the spine to
these disorders.
Dysphagia can develop from cranial
neuropathies, physical obstruction,
degenerative disease, traumatic injury,
or any combination of the above. The
interplay between cervical and cranial
nerves is an important element in the
severity of dysphagia, and contributions from the cervical nerves are often
overlooked — granted, they may be
more involved with structural support
than the mechanics of deglutition, since
most sensory and functional input to
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DYSPHAGIA ASSESSMENT AND TREATMENT PLANNING: A TEAM APPROACH
swallowing is mediated by the cranial
nerves. Cervical structural support is
thought to be primarily attributed to
muscle function from the long muscles
with attachments to multiple cervical
levels, particularly longus colli and longus capitis through the cervical plexus
(Mann et al., 1999). It has been observed
that less than half of patients with quadriplegia have dysphagia despite no cervical nerve contribution (Shem et al.,
2012). The most likely explanation for
the degree of cervical and cranial nerve
roles in dysphagia is a continuum of
various contributions from each component that is highly dependent on the
specific pathology.
ANATOMIC CONSIDERATIONS
Congenital Anomalies
Congenital cervical spine anomalies
are commonly associated with dysphagia in young children. However,
many of these patients are affected by
global developmental delay or other
anatomic deformities that make it difficult to rigorously evaluate and attribute
dysphagia to the cervical changes. Not
surprisingly, these complexities represent a serious challenge for identifying
appropriate therapies for dysphagia
management. Although congenital
anomalies can persist throughout life,
it is uncommon for dysphagia to present as a new symptom among adults
with congenital anomalies. When a
congenital anomaly contributes to a
swallowing disorder in a delayed fashion, this is usually through progressive
worsening of cranial neuropathies,
particularly those at the level of the
craniocervical junction that affect the
vagus, glossopharyngeal, and hypoglossal nerves (Kang & Moon, 2016;
Kotil et al., 2007; Song et al., 1996). One
particular, uncommon congenital issue
that sometimes presents in adulthood
is the aberrant right subclavian artery
(lusorian artery). On detailed history,
dysphagia has usually been present for
many years but either unrecognized in
the face of more problematic symptoms
or not appreciated by the patient since
they did not recognize it was abnormal
(Figure 19–1).
Scoliosis
Scoliosis is abnormal curvature of
the spine in the lateral plane (seen on
anteroposterior view) of greater than
10 degrees as measured by Cobb angle.
Scoliosis most commonly affects the
lumbar and thoracic spine, but the cervical spine can be involved. Compression of the esophagus in the thorax
or the pharyngoesophageal segment
(PES) can cause dysphagia by extraluminal narrowing (Bar-On et al., 1998;
Papadopoulou et al., 2013). In some
instances, patients who have suffered a
stroke leading to persistent hemiplegia
may develop cervical scoliosis due to
lateral neck flexion toward the strong
side with muscle contracture. A similar
outcome may arise from chronic muscle spasticity or contraction in cerebral
palsy or Parkinson’s disease.
Kyphosis and Lordosis
Measurement of cervical kyphosis or
lordosis is accomplished through Cobb
angles of either the occipital to second
cervical planes (O–C2) or C2–C7 planes.
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Figure 19–1. Dysphagia lusoria (Latin for natural anomaly) was described in
1787 and is the consequence of abnormal development of the pharyngeal
arch arteries. An AP image from a barium esophagram (A) shows the indentation of the esophagus from the aberrant right subclavian artery in the upper
mediastinum, while the vessel’s takeoff from the aorta is shown in the axial CT
scan image in (B) with posterior compression of the esophagus in (C).
Reduction at the O–C2 level causes
Osteophytes
a relative mandible retrusion into the
oropharynx, which limits the oropharyngeal inlet, and combined with the
hyperlordosis can project the anterior
cervical spine into the pharynx (Ota et
al., 2011; Tian & Wu, 2013). The C2–C7
angle reflects lower cervical curvature,
where excessive kyphosis (Figure 19–2)
causes swallowing impairment (Mummaneni et al., 2006; Randall et al., 2017).
Though still unclear, dysphagia may be
attributable to cervical myelopathy or
progressive ligament and muscular laxity due to changes on the suspensory
forces in these cases of more severe anatomic alteration.
Osteophytes are bony outgrowths from
joint margins and can occur anywhere
in the body, typically due to osteoarthritis or degenerative joint disease.
Approximately one third of the weight
of the head and axial load is supported
in the anterior column of the spine,
with the remainder supported by the
posterior column and facet joints; when
muscle laxity and decreased joint stability develop, inflammation at the joint
edges build and osteophytes grow as a
physiologic response (Cho et al., 2019).
In the cervical spine, posterior osteophytes arise from the articular processes
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DYSPHAGIA ASSESSMENT AND TREATMENT PLANNING: A TEAM APPROACH
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Figure 19–2. Severe scoliosis in a young adult male. A. AP radiographic indicating
degree of thoracic scoliosis. B. Axial CT scan showing relative position of epiglottis
tip (arrow ) and vertebrae oriented perpendicular to each other. The spinal canal is
indicated with an asterisk. C. Demonstration of compression of esophagus by lateral
process of vertebrae (small black airspace marked by white arrow
ventricle (white arrowhead
) and surrounding thyroid cartilage at the same height.
), with the laryngeal
and facets to impinge on the spinal
roots, where they may cause radiculopathy or myopathy. Anterior osteophytes extend from the anterior margin
of the upper and lower borders of the
cervical vertebrae to appear as small or
large bony protrusions that can cause
external compression of the pharynx
(Figure 19–3). As they are consequences
of degenerative spine disease and instability, these entities commonly coexist.
The anterior and posterior surfaces of
the vertebral bodies are lined with ligaments called the anterior longitudinal
Figure 19–3. Cervical kyphosis with rever-
sal of normal cervical lordosis.
ligament and posterior longitudinal
ligament, respectively. These ligaments,
as well as the fibrous margins of the
intervertebral discs (annulus fibrosus),
can also ossify, which are termed enthesophytes in the former and syndesmophytes in the latter. Syndesmophytes
represent the classic radiologic finding in the “bamboo spine” of ankylosing spondylosis. Pathophysiologically,
osteophytes, enthesophytes, and syndesmophytes all develop from similar
pathways of inflammation and secondary ossification.
Osteophytes are the most common
natural development in the cervical
spine connected to dysphagia. Osteophytes with cervical degenerative disc
disease are very prevalent radiographic
findings in asymptomatic patients and
have been found in 27% of people under
the age of 50 and in 86% of those older
than 50 in a Japanese population-based
study, with C5/6 the most frequently
affected level at all ages and genders
(Teraguchi et al., 2014). Osteophytes
may involve single or multiple levels,
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and if four or more contiguous levels
are involved, then it is termed diffuse
idiopathic skeletal hyperostosis (DISH).
In the presence of DISH, dysphagia is
reported in up to 28% of patients (Lambert et al., 1981) (Figure19–4). Mechanisms proposed to explain dysphagia
resulting from osteophytes include
narrowing of the oropharynx, reduced
pharyngeal wall contraction, inflamma-
tory restriction of laryngeal elevation
and tissue adhesion, impeded epiglottic inversion, bolus obstruction in the
esophagus or PES, retained bolus and
secondary aspiration or penetration,
or deflection of material directly into
the larynx (Carlson et al., 2011; Papadopoulou et al., 2013). There is poor
correlation between osteophytes and
dysphagia, with multiple small-scale
Figure 19–4. Examples of large osteophytes. A. Multiple large anterior cervical
spine osteophytes altering contour of posterior pharyngeal wall and impinging on upper esophageal sphincter opening. Since there are at least four
contiguous levels involved, this is classified as diffuse idiopathic skeletal hyperostosis (DISH). B. Endoscopic appearance of a large osteophyte causing obliteration of the left hypopharyngeal inlet. Even with Valsalva, the hypopharynx
was inaccessible. The same patient is shown in a videofluoroscopic swallowing study prior to (C) and during (D) a swallow. Note that in (D), a portion of
the bolus passes to the side of the osteophyte and preferentially into the right
hypopharynx.
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