Postswallow aspiration secondary to stenosis of the upper esophageal sphincter.
A 73-year-old man came to our center seeking care for dysphagia and aspiration 2 months after he had experienced a cerebrovascular accident. He was dependent on a percutaneous endoscopic gastrostomy tube. A fiberoptic endoscopic evaluation of swallowing with sensory testing revealed pooling in the posterior glottis and pyriform sinuses with postswallow aspiration and evidence of outlet obstruction at the level of the cricopharyngeal segment. Laryngeal sensory thresholds were normal (<4 mm Hg). A modified barium swallow examination confirmed the postswallow aspiration and revealed a stenotic cricopharyngeal segment. Figures 1 through 5 are photographs obtained during the barium swallow examination showing the series of events during swallowing. The patient underwent bougie (60 French Maloney) dilation of the upper esophageal sphincter. Postoperatively, the patient was treated with transcutaneous electrical stimulation. He is currently tolerating a regular diet by mouth without difficulty.
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