Volume 24, Issue 103, May - June, 2020

Aero-digestive symptoms in cervical spine disorders- A neglected entity

Shraddha Jain^1♦, Shyam Jungade², Deepshikha Chandravanshi³

¹MBBS, MS (ENT), PhD, Professor, Department of Otorhinolaryngology, Jawahar Lal Nehru Medical College, Datta Meghe Institute of Medical Sciences (Deemed to be University), Sawangi (M), Wardha, Maharashtra, India-442004
²BPTh, MPT, (Community Based Rehabilitation), Associate Professor, Department of Community Health Sciences, Maharashtra Institute of Physiotherapy, Latur, Maharashtra, India.
³Resident, Department of Otorhinolaryngology, Jawahar Lal Nehru Medical College, Datta Meghe Institute of Medical Sciences (Deemed to be University), Sawangi (M), Wardha, Maharashtra, India-442004

^♦Corresponding author
Professor, Department of Otorhinolaryngology, Jawahar Lal Nehru Medical College, Datta Meghe Institute of Medical Sciences (Deemed to be University), Sawangi (M), Wardha, Maharashtra, India; Email: sjain_med@yahoo.co.in

ABSTRACT

Background: Dysphagia in elderly could be attributable to a number of etiological causes like stroke, malignancies, motility disorders, cervical osteophytic compression, changes in cervical spine curvature and diffuse idiopathic skeletal hyperostosis (DISH). Cervicogenic dysphagia, dysphonia and stridor in elderly are often an under diagnosed entity in otorhinolaryngology practice. The current study was undertaken to correlate the occurrence of upper aerodigestive tract symptoms with various cervical spine disorders. Material and Methods: A retrospective study of 7 patients presenting with upper aerodigestive tract symptoms from January 2016 –December 2017. A detailed otorhinolaryngological examination, radiologic investigations in the form of xray neck, fluoroscopy, CT scan, endoscopic assessment of upper aero-digestive tract were done to rule out intraluminal and extraluminal causes of dysphagia, airway and voice symptoms. Results: Dysphagia and odynophagia are the most common otolaryngological manifestation of cervical spine disorders due to anterior osteophytes compressing the pharynx or esophagus or due to change in the curvature of the cervical spine. Dysphonia and dyspnea result from vocal cord immobilization and arytenoid oedema. The diagnosis is verified by endoscopy combined with appropriate radiological study. Correction of cervical lordotic curvature by manual therapy, resulted in improvement of dysphagia associated with loss of cervical lordotic curvature. Conservative treatment was offered for other symptoms. Conclusion: This is probably first otolaryngological study to have correlated endoscopic findings in patients of dysphagia, dysphonia and dyspnea with cervical spine abnormalities. Dysphagia can occur due to anterior cervical osteophytesor change in cervical spine curvature. Cervicogenic aerodigestive symptoms are only diagnosis of exclusion.

Keywords: Cervical spine; Lordosis; Dysphagia; Manual therapy; Elderly; Diffuse idiopathic skeletal hyperostosis (DISH); Forestier’s disease; Vocal cord immobilization; Stridor

Medical Science, 2020, 24(103), 1757-1763

PDF