• Koichi Tsunoda, Hiroko Satoh, and Yoko Morita.
• National Institute of Sensory Organs, Artificial Organs, Meguroku, Tokyo, 152-8902, Japan.
• BMJ Case Rep. 2009 Jan 1;2009.

AbstractA 64-year-old-man visited our clinic because of dysphagia and hoarseness. Fibreoptic laryngoscopic examination revealed pooling of saliva around his pharynx and larynx. However, the glottal closure was perfect without laryngeal paralysis in phonation, and the hoarseness was caused by the vibration of aspirated saliva. We also noted severe ptosis in both eyes. According to the patient and his family, the ptosis and dysphagia had been recognised 5 years previously. The ptosis forced him to extend his neck upward when swallowing since it prevented the head down or ordinary position, and thus satisfactory laryngeal elevation could not be achieved while swallowing. We consulted the reconstructive surgical department concerning the patient's ptosis. After reconstructive surgery, the ptosis resolved and the patient was able to swallow without difficulty. Postoperative fibreoptic laryngoscopic examination showed that the saliva pooling sign had disappeared in both pyriform recesses. The patient's hoarseness had also disappeared.

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