The diagnosis and treatment of osteophyte-induced dysphagia can be both challenging and frustrating. DISH is a common finding in the adult population and, like the complaint of dysphagia, increases with age. Clearly, it is a small percentage of cervical osteophytes that present upper aerodigestive difficulties. After excluding other causes of dysphagia, conservative treatment is indicated in the initial management of this disorder and should relieve symptoms in the majority of patients. Surgical management should be reserved for severe and recalcitrant symptoms, and the patient must understand that surgery does not guarantee complete resolution of symptoms. Special thanks to Jerry Basto for his assistance in manuscript preparation.

Among various forms of hearing loss, there are acute (within 72 hrs) or subacute (weeks to months) presentations that may be reversible with early pharmacological intervention. The workup of a patient presenting with hypoacusia includes the usual history and physical examination in conjunction with an audiometric assessment in order to categorize the hearing loss as conductive, sensorineural, or mixed. Sudden sensorineural hearing loss and autoimmune inner ear disease are acute and subacute forms of sensorineural hypoacusia most likely to be reversed with prompt pharmacological intervention. Systemic or local corticosteroid therapy has the most evidence of benefit in patients with sudden sensorineural hypoacusia and is the best available first line therapy noted in clinical practice guidelines. Alternative immunosuppressant therapies have not been well studied, and many have serious toxicities that further complicate the benefit-risk assessment. There are no randomized comparisons of corticosteroid dosing regimens that evaluated clinically important outcomes, so expert opinion must serve as the basis for dosing recommendations. Clinicians need to involve patients with hypoacusia in the shared decision-making process, since partial or complete reversal of hearing loss can have substantial quality-of-life implications for affected patients.