A Case Report of Latent Dysphagia due to Cervical Vertebral Body Osteophytes Manifesting after COVID-19 Infection

Abstract

　Introduction: A patient who developed aspiration pneumonia and fasted during hospitalization for COVID-19 infection underwent a videofluoroscopic examination (VF) of swallowing. VF showed that cervical vertebral body osteophytes had caused inversion of the epiglottis and obstruction of the passage of food mass through the fossa pellucida. In addition, when the patient was evaluated by videoendoscopic examination (VE) of swallowing, VE was achieved by postural adjustment and compensatory swallowing.

　Case: A man in his early 80s who had difficulty swallowing solid foods since before his illness was admitted to our hospital with COVID-19 and his condition stabilized with medication, but he developed aspiration pneumonia. He was admitted to our hospital for rehabilitation.

　Progress: Initially, the patient was fasting and VF was performed. At that time, cervical vertebral osteophytes (around C4–6) were observed, which inhibited inversion of the glottis, and the passage of the food mass through the pisiform fossa was also poor. We did not perform surgery, but started step-by-step feeding training. We also examined compensatory swallowing methods under VE, and were able to reduce the residual volume by performing an anterior tilt and chin down movement. Alternate swallowing of water without thickening was also used to safely reduce residual volume. Residuals could be self-sucked out. By combining anterior tilt, chin down, alternate swallowing with unthickened water, and self-extubation after swallowing, the patient was able to eat three normal meals orally and was discharged home.