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Inflammatory Myopathy Causing Pharyngeal Dysphagia: A New Entity

Seven patients presented to our swallowing center with solid food dysphagia. The age range at presentation was 69 to 90 years. All patients had normal findings on neurologic evaluation, and in those patients undergoing electromyography and nerve conduction studies, results of all such tests were also normal. Pooling of saliva in the pharyngeal recesses was noted on fiberoptic laryngoscopy in most cases. The swallowing videofluoroscopy findings were strikingly similar. All patients had a prominent cricopharyngeus muscle, and some had a prominence in a more proximal portion of the inferior constrictor muscle. All patients had decreased epiglottic tilt and moderate or severe residue in the pharyngeal recesses. Three patients underwent pharyngoesophageal sphincter myotomy. Biopsies of the omohyoid and cricopharyngeus muscles showed inflammatory myopathy with no evidence of inclusion bodies. This is a distinct clinical entity defined by isolated pharyngeal dysphagia in elderly patients with a unique videofluoroscopic appearance and pharyngeal myopathy.