Videofluoroscopic Swallowing Study–Guided Balloon Dilation for Dysphagia after Subclinical Recurrent Laryngeal Neuropathy Following Hanging
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This case report highlights the effectiveness of Videofluoroscopic Swallowing Study-guided balloon dilation in managing dysphagia resulting from subclinical recurrent laryngeal nerve (RLN) neuropathy after a non-lethal hanging attempt. A 71-year-old male presented with dysphagia following an attempted hanging. The initial assessments revealed neck pain, soft tissue edema, and a fractured hyoid bone. Despite stable respiratory findings, the patient had significant swallowing difficulties. The patient underwent a VFSS that revealed an upper esophageal sphincter (UES) dysfunction linked to bilateral RLN neuropathy. After conventional dysphagia therapy, VFSS-guided balloon dilation was performed on day 46 after a tracheostomy. Following the procedure, significant improvement in swallowing function was noted, with the Penetration–Aspiration Scale (PAS) score decreasing from 5 to 2. The intervention was well-tolerated, with no significant adverse events reported. VFSS-guided balloon dilation is a safe and effective treatment option for dysphagia caused by an impaired UES opening resulting from subclinical RLN neuropathy after hanging. Further studies with larger populations will be needed to validate these findings and refine the treatment protocols.
Abstract
This case report highlights the effectiveness of Videofluoroscopic Swallowing Study-guided balloon dilation in managing dysphagia resulting from subclinical recurrent laryngeal nerve (RLN) neuropathy after a non-lethal hanging attempt. A 71-year-old male presented with dysphagia following an attempted hanging. The initial assessments revealed neck pain, soft tissue edema, and a fractured hyoid bone. Despite stable respiratory findings, the patient had significant swallowing difficulties. The patient underwent a VFSS that revealed an upper esophageal sphincter (UES) dysfunction linked to bilateral RLN neuropathy. After conventional dysphagia therapy, VFSS-guided balloon dilation was performed on day 46 after a tracheostomy. Following the procedure, significant improvement in swallowing function was noted, with the Penetration–Aspiration Scale (PAS) score decreasing from 5 to 2. The intervention was well-tolerated, with no significant adverse events reported. VFSS-guided balloon dilation is a safe and effective treatment option for dysphagia caused by an impaired UES opening resulting from subclinical RLN neuropathy after hanging. Further studies with larger populations will be needed to validate these findings and refine the treatment protocols.