[DYSPHAGIA] Interesting case

[QuinnD@rvh.on.ca (Quinn, Darin)]

I had an interesting outpatient case yesterday in our clinic and I'm stumped
as to where to go next:

Healthy 32 year old male with a two year history of dysphagia with solids
(mostly hard or chewy, eg. bread, pizza, apples) but never liquids.  He
described the problem as follows: on a daily basis while eating, he chews
something, pushes it to the back of the mouth and into the throat, but then
nothing happens and he has to bring it back up with forceful gagging and/or
coughing.  Once this happens, he stops eating and then later on, everything
works fine again.  There is no apparent pattern to the sudden dysphagia as
far as time of day, type of food, stress level, etc. though he said that it
seems to happen more often toward the end of a meal when he is almost full
(but other times it happens on the first bite).  The dysphagia has been
stable over its two year history and he could not think of anything
significant that occurred at the time it started.  He did appear quite
anxious when describing the problem and said (understansably) that it is
very worrisome to him.  I asked him briefly about stress but he said that
this can happen even when he's having a great day and feels perfectly
relaxed.

Another other possibly related complaint was of a couple of sudden instances
(approx. 3 in the last two years) of his 'throat locking up' for up to 1
minute.  During these episodes, he feels he cannot get any air in or out and
then everything returns to normal once the 'spasm' passes.  These did not
coincide with eating and also showed no particular pattern.

No significant medical history was noted and he is not on any medication. He
quit smoking one year ago.  His weight is healthy and stable and he has not
had pneumonia.  He denied any symtpoms of heartburn, dysphonia, and does not
experience globus.  ENT examination was normal, as was upper GI series.  He
reported no family history of dysphagia.  There are no known food allergies.

On examination, oral motor assessment was normal.  VFSS was also normal with
all consistencies, in both views in terms of timing, coordination, and
oral/pharyngeal clearance.  No overt anatomical abnormality was noted.  

Any ideas?

Thanks in advance,

Darin


Darin Quinn, MSc.
Speech-Language Pathologist
The Royal Victoria Hospital of Barrie
201 Georgian Drive
Barrie, Ontario  L4M 6M2
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