Dysphagia, Odynophagia, Hoarseness in Elderly Man

Figure 1. Flexible fiberoptic laryngoscopy demonstrating vesicular lesions of the hemilarynx, a paralyzed right vocal fold and pooling of secretions.

Presentation: A 97-year-old man presented with one week of worsening dysphagia, odynophagia and a mild hoarseness. The patient was able to tolerate a normal diet. Flexible fiberoptic laryngoscopy revealed a small ulcer of the right aryepiglottic fold, with normal vocal fold movement. Over the next two days, his dysphagia worsened, and he was no longer able to tolerate liquids.

Esophagogastroduodenoscopy was performed, and the only abnormality was a Schatzski ring at the gastroesophageal junction. A modified barium swallow study showed aspiration and hypopharyngeal pooling of contrast. Contrast enhanced computed tomography of the neck did not reveal any abnormality. The following day, a flexible fiberoptic laryngoscopy revealed ulcerations of the right hemilarynx, pooling of secretions and a complete right vocal fold paralysis (Figure 1). The left hemilarynx was unaffected.

—John M. Carter, MD, David Cai, MD and Brian A. Moore, MD, Tulane University School of Medicine and Ochsner Clinic Foundation, New Orleans.

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