Dysphagia and aspiration secondary to polymyositis. (Esophagoscopy Clinic).

A 35-year-old woman with a history of polymyositis was evaluated for signs and symptoms of aspiration. Flexible endoscopic evaluation of swallowing with sensory testing revealed that she had a diminished laryngeal sensation, no pharyngeal squeeze, severe endolaryngeal penetration (figure, A), and postswallow aspiration (figure, B). Findings on transnasal esophagoscopy were normal. Manometry revealed normal relaxation of the upper esophageal sphincter(UES), but no pharyngeal contraction (figure, C, shows normal UES relaxation and normal pharyngeal contraction, and figure, D, shows normal UES relaxation and no pharyngeal contraction). The patient was offered a laryngeal suspension, cricopharyngeal myotomy, and neurorrhaphy of the great auricular and superior laryngeal nerves, but she declined for personal reasons. A percutaneous enterogastric tube was placed on an outpatient basis.

From the Center for Voice Disorders, Department of Otolaryngology, Wake Forest University Medical Center, Winston-Salem, N.C.; www.thevoicecenter.org