Differential Diagnosis

The patient presents with a complex set of symptoms including difficulty swallowing, shortness of breath, dryness, and an inability to sing, alongside a history of prolapse mitral valve, chronic sinus congestion, silent reflux, chemical sensitivities, and a previous turbinate reduction. Considering these symptoms and history, the differential diagnosis can be categorized as follows:

• Single Most Likely Diagnosis

  • Gastroesophageal Reflux Disease (GERD): The patient's history of silent reflux, difficulty swallowing, and shortness of breath could be indicative of GERD, which has likely worsened over time. The chronic nature of reflux can lead to esophageal irritation and potentially cause the symptoms described.

• Other Likely Diagnoses

  • Eosinophilic Esophagitis: Given the patient's difficulty swallowing and history of silent reflux, eosinophilic esophagitis is a consideration. This condition involves an immune response to food or environmental allergens, leading to esophageal inflammation and symptoms similar to those described.
  • Vocal Cord Dysfunction: The patient's inability to sing and shortness of breath could suggest vocal cord dysfunction, which might be exacerbated by or related to the patient's history of silent reflux and chemical sensitivities.
  • Chronic Rhinosinusitis: The patient's history of chronic sinus congestion and previous turbinate reduction suggests chronic rhinosinusitis, which could contribute to the overall symptomatology, including shortness of breath and dryness.

• Do Not Miss Diagnoses

  • Achalasia: Although less common, achalasia is a serious condition characterized by difficulty swallowing due to esophageal motility issues. It's crucial to rule out achalasia due to its significant impact on quality of life and potential for complications.
  • Esophageal Cancer: Given the patient's age and symptoms of difficulty swallowing, it's essential to consider esophageal cancer, although it is less likely. Early detection is critical for treatment outcomes.
  • Pulmonary Embolism: While the patient's shortness of breath could have several explanations, pulmonary embolism is a life-threatening condition that must be ruled out, especially if there are any acute changes in symptoms.

• Rare Diagnoses

  • Sjögren's Syndrome: This autoimmune disorder can cause dryness in the eyes, mouth, and other areas, which aligns with the patient's complaint of dryness. It's less common but could explain some of the patient's symptoms, especially if there are other systemic symptoms.
  • Amyloidosis: Involvement of the esophagus or lungs by amyloid deposits could potentially explain some of the patient's symptoms, although this would be a rare and unusual presentation.