Abstract
Introduction: There have been few reports of dysphagia and swallowing rehabilitation in Ramsay Hunt syndrome caused by varicella-zoster virus. We report three cases of patients with dysphagia due to lower cranial neuropathy.
Case 1: A man in his 70s complained of sore throat, dysphagia, and hoarseness. Videoendoscopic examination of swallowing (VE) and videofluorography (VF) revealed left vocal cord paralysis, poor pharyngeal contraction, a large amount of pharyngeal residue, impaired passage of upper esophageal sphincter (UES), and silent aspiration. High-resolution manometry (HRM) showed a reduced intrapharyngeal pressure during swallowing, reduced UES pressure at rest on both sides, and high pressure below the UES on the healthy side. He was diagnosed with left glossopharyngeal and vagal nerve disorders and underwent direct training with the head rotated to the unaffected side.
Case 2: A woman in her 70s complained of sore throat, swallowing difficulty, hoarseness, and right ear eruption. VE and VF showed right soft palate and vocal cord paralysis, poor pharyngeal contraction, and a large amount of pharyngeal residue. HRM showed a reduced intrapharyngeal pressure during swallowing on both sides, and a slight reduced UES pressure at rest on the affected side. She was diagnosed with right glossopharyngeal and vagal nerve disorders.
Case 3: A man in his 60s complained of right posterior neck pain, hoarseness, and dysphagia. He had right soft palate paralysis and vocal cord paralysis. VF showed a large amount of pharyngeal residue. HRM showed a reduced intrapharyngeal pressure during swallowing, and a reduced UES pressure at rest on both sides. The nasopharyngeal pressure increased during head rotation to the affected side. He was diagnosed with right glossopharyngeal, vagal, and accessory nerve disorders.
Discussion: The common findings of these three cases were poor pharyngeal contraction, vocal cord paralysis, and bolus retention in the piriform recess sinus. HRM showed a reduced intrapharyngeal pressure during swallowing on both sides, and a reduced UES pressure at rest on the affected side. Nadir UES pressure and UES relaxation time were in the normal range. VF and HRM are useful for physiological evaluation of dysphagia and decision-making for swallowing rehabilitation in this syndrome.
