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Clicking Sensation on Swallowing

Educational Objective
Based on this clinical scenario and the accompanying image, understand how to arrive at a correct diagnosis.
1 Credit CME

A 42-year-old woman (height, 160 cm; weight, 50 kg) presented with a 3-month history of a clicking sensation and painful swallowing, mainly on the right side, with a sudden onset. She had consulted other physicians, but the cause could not be identified. The symptoms gradually exacerbated, seriously deteriorating her quality of life and causing a 5-kg weight loss. She also experienced insomnia and depression. Antidepressants and psychotherapy, prescribed under the suspicion of a psychogenic cause, did not alleviate her symptoms. She had no relevant medical history and no smoking or drinking history. Cardiovascular, respiratory, and neurological findings were unremarkable.

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D. Clicking larynx

Normally, a space is present between the thyroid cartilage and the hyoid bone during swallowing. The severe rubbing between the hyoid bone and the thyroid cartilage during swallowing caused the clicking sensation and cervical pain; thus, we diagnosed her with a clicking larynx. Because conservative therapy, including physiotherapy, analgesic injections, and medications, was ineffective, surgery was performed under local anesthesia to identify sites in contact on swallowing. On visualization of the structures during swallowing, the right superior part and the superior notch of the thyroid cartilage were found to contact the hyoid bone. The thyroid cartilage was partially excised (Figure 2A). The operation conferred immediate improvement, and complete symptom relief was noted at the 3-month follow-up. The 3-month postoperative SD-CT revealed no contact between the hyoid bone and the thyroid cartilage (Figure 2B).

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Article Information

Corresponding Author: Rumi Ueha, MD, PhD, Swallowing Center, University of Tokyo Hospital, 7-3-1 Hongo Bunkyo-ku, Tokyo, Japan, 113-8655 (uehar-oto@h.u-tokyo.ac.jp).

Published Online: June 10, 2021. doi:10.1001/jamaoto.2021.1137

Conflict of Interest Disclosures: Dr Ueha reported receiving grants from the Japan Society for the Promotion of Science (No. 16KT0190) related to the submitted work; and grants from the Japan Society for the Promotion of Science (No. 17K11378, No. 19K09841, and No. 20K10069) outside the submitted work. No other disclosures were reported.

Funding/Support: This work was supported by Japan Society for the Promotion of Science KAKENHI Grant-in-Aid for Scientific Research (grant No. 16KT0190).

Role of the Funder/Sponsor: The funder had no role in the preparation, review, or approval of the manuscript and decision to submit the manuscript for publication.

Additional Contributions: We thank the patient for granting permission to publish this information. We also gratefully acknowledge Eriko Maeda, MD, PhD, Taku Sato, MD, Takao Goto, MD, and Tatsuya Yamasoba, MD, PhD, for preparing the manuscript. They did not receive compensation for their contributions.

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