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Laryngology/Broncho-Esophagology

(063) Bilateral Vocal Fold Motion Impairment Associated with DISH

Monday, October 2, 2023
2:45 PM – 3:45 PM East Coast USA Time
Has Audio

    Presenting Author(s)

  • Diego Esau Razura, BS

    Medical Student
    Caruso Department of Otolaryngology – Head and Neck Surgery, Keck School of Medicine, University of Southern California 2.East Tennessee State University-Quillen College of Medicine
    Johnson City , Tennessee, United States

    • Co-Author(s)

  • Elizabeth A. Shuman, MD

    Assistant Professor
    Caruso Department of Otolaryngology – Head and Neck Surgery, Keck School of Medicine, University of Southern California
    Los Angeles, California, United States

  • Michael M. Johns III, III, MD

    Professor
    Caruso Department of Otolaryngology – Head and Neck Surgery, Keck School of Medicine, University of Southern California
    Los Angeles, California, United States

    • Senior Author(s)

  • KO

    Karla D. O'Dell, MD

    Assistant Professor
    Caruso Department of Otolaryngology – Head and Neck Surgery, Keck School of Medicine, University of Southern California
    Shermwn Oake , California, United States

Disclosure(s):
Diego Esau Razura, BS: No relevant relationships to disclose.
Elizabeth A. Shuman, MD: No relevant relationships to disclose.
Karla D. O'Dell, MD: No relevant relationships to disclose.


Introduction: Diffuse idiopathic skeletal hyperostosis (DISH) is a primarily asymptomatic condition characterized by the calcification of the anterolateral vertebral ligaments, but in rare instances, have been reported to cause dysphonia due to laryngeal involvement. We aimed to describe the clinical courses and interventions of four patients with bilateral vocal fold motion impairment (BVFMI) attributed to DISH.

Methods: In a case series, four male patients were evaluated and treated for their symptomatic DISH-associated BVFMI over the course of approximately one year. Clinic notes, diagnostic studies, operative reports, flexible nasolaryngoscopy, and postoperative data were analyzed. Factors including demographic data, symptom severity, comorbidities, level and size of osteophytes, interventions, complications, and voice and breathing outcomes were considered. Interventions ranged from conservative voice therapy to surgical treatment.

Results: All patients were found to have symptomatic BVFMI attributed to cervical spine DISH seen on imaging. Symptoms ranged from life-threatening dyspnea to breathy dysphonia. Each patient was offered surgery for DISH. Two patients underwent osteophyte removal at the C5-C6 level with improved vocal fold mobility, breathing, and voice. Two patients elected serial observation as voice, swallow, and airway symptoms were manageable.

Conclusions: BFVMI is a rare manifestation of cervical spine DISH, thought due to neurologic and/or mechanical impingement of the laryngeal framework. Both surgical and conservative (e.g., voice therapy) intervention may be considered for symptomatic relief and improvement in vocal fold mobility on a patient-to-patient basis. Further study is warranted to investigate the etiology and treatment outcomes in these cases.