A nationwide survey of dysphagia as a complication of deep neck infection with abscess in Japan.

Objective: Deep neck infection with abscess (DNI) may cause dysphagia as a late complication. This study aimed to determine the rate of DNI related dysphagia (DNIRD) and the effectiveness of rehabilitation and surgery for DNIRD.

Methods: As a multicenter retrospective study, we conducted a nationwide survey by sending questionnaires to specialist training institutions certified by the Japan Broncho-esophagological Society (JBES). The questionnaire was sent to 227 facilities. This survey targeted patients with DNI aged 20 years or older who were hospitalized after April 1, 2011 and discharged by March 31, 2021.

Results: Of the 1058 cases of DNI included in this study, DNIRD was observed in 161 of 1058 patients (15.2 %). Of the 1058 cases of DNI, 139 cases showed descending necrotizing mediastinitis (DNM) (13.1 %), and DNIRD was observed in 64 of the DNM cases (46 %). DNIRD cases tended to be older (71 ± 13.5 vs. 64 ± 17.7 years old, p < 0.001), have a higher tracheostomy rate (91.3 % vs. 43.7 %, p < 0.0001), and have a longer hospital stay (51 ± 34.7 vs. 17 ± 15.4 days, p < 0.0001) than non-DNIRD cases. There were 125 cases in which only rehabilitation was performed, 8 cases in which surgery was performed to improve swallowing function, and 28 cases in which the natural course was observed. The improvement rates of DNIRD in the natural history group, rehabilitation group, and surgery group were 78.6 %, 91.8 %, and 100 %, respectively, and the rehabilitation group tended to improve more than the natural course group (p = 0.08).

Conclusion: This nationwide survey revealed that 15.2 % of patients with DNI resulted in DNIRD and that 46 % of descending necrotizing mediastinitis patients developed DNIRD. Rehabilitation for DNIRD is generally useful, and that additional surgical treatment can improve outcomes for DNIRD patients where rehabilitation alone is not effective.