Potential Dysphagia Following COVID-19 Infection Due to Cervical Osteophytes: A Case Report

The epiglottis separates the pharynx from the larynx by flipping upward to prevent swallowed material from entering the airway. Cervical vertebral osteophytes can interfere with this movement, potentially leading to dysphagia. Videofluoroscopic (VF) and videoendoscopic (VE) examinations of swallowing are valuable tools for understanding the pathophysiology of dysphagia and for formulating appropriate rehabilitation plans. A 77-year-old man with pre-existing dysphagia for solid foods was hospitalized for coronavirus disease 2019 (COVID-19). He stabilized with antiviral and supportive therapy but developed aspiration pneumonia on the sixth day of hospitalization. Rehabilitation therapy was initiated on day 7. Upon admission, the patient was kept fasting, and a VF swallowing study was performed. This revealed cervical vertebral osteophytes at the C3/4 and C4/5 levels that impeded epiglottic inversion and hindered bolus passage through the pyriform sinus. It was considered that dysphagia became apparent following COVID-19 infection, leading to aspiration pneumonia. Surgery was not performed, and progressive feeding training was initiated. Under VE evaluation, compensatory swallowing strategies were explored. Pharyngeal residue was reduced by adopting a forward-leaning posture and performing chin-down maneuvers. Alternating swallows of unthickened liquids further minimized pharyngeal residue, which the patient could expel independently. By combining the forward-leaning and chin-down postures, alternating swallows of unthickened liquids, and self-expulsion after swallowing, the patient successfully resumed oral intake of three regular meals and was discharged home. The primary cause of dysphagia in this case was presumed to be cervical vertebral osteophytes, with symptoms becoming apparent following COVID-19 infection. It is important to recognize that dysphagia can arise from cervical spine deformities even in the absence of neurological abnormalities. In this patient, compensatory swallowing techniques such as the forward-leaning posture and chin-down position promoted favorable deformation of the pharyngeal cavity and reduced pharyngeal residue. This case underscores the importance of identifying the underlying cause of dysphagia and implementing appropriate risk mitigation strategies.