Knopke S, Coordes A, Ernst A, Seidl R O
Klinik für Hals-, Nasen-, Ohrenheilkunde, Unfallkrankenhaus Berlin.
HNO. 2012 Mar;60(3):279-81. doi: 10.1007/s00106-011-2405-x.
A 49-year-old woman was referred to the ENT department with a 1.5-year history of dysphagia accompanied by globus sensation and regurgitation as well as recurrent syncopal attacks associated with swallowing solid foods.
Endoscopic examination revealed hyperplasia of the tongue base and redness of the aryepiglottic region. An axial hiatal hernia (> 3 cm) was seen on esophago-gastro-duodenoscopy. Esophageal manometry showed a diffuse esophageal spasm. Holter monitoring (24 h) revealed a third-degree atrioventricular block.
The patient’s symptoms resolved following placement of a permanent cardiac pacemaker. Globus sensation and regurgitation persisted. Treatment with proton pump inhibitors was successful. The final functional endoscopic evaluation of swallowing revealed no relevant findings.
We describe a case of a rare and extreme form of a vagal reflex. Deglutition syncope can be successfully treated by a multidisciplinary team consisting of otorhinolaryngologists, neurologists and cardiologists.
一名49岁女性因吞咽困难伴咽部异物感、反流1.5年，以及吞咽固体食物时反复出现晕厥发作，被转诊至耳鼻喉科。
内镜检查发现舌根增生，杓会厌区域发红。食管-胃-十二指肠镜检查发现有一个轴向裂孔疝（>3cm）。食管测压显示弥漫性食管痉挛。动态心电图监测（24小时）显示三度房室传导阻滞。
植入永久性心脏起搏器后患者症状缓解。咽部异物感和反流症状持续存在。质子泵抑制剂治疗成功。吞咽功能的最终内镜评估未发现相关异常。
我们描述了一例罕见的极型迷走神经反射病例。吞咽性晕厥可由耳鼻喉科医生、神经科医生和心脏病专家组成的多学科团队成功治疗。
