In Reply We would like to thank Dr Govil et al1 for their insight into this potentially devastating diagnosis in patients with irradiated head and neck cancer, and for adding further patient data to be considered. Indeed, cervical spine spondylodiscitis can be a challenging diagnosis, especially when detected only on surveillance imaging in an otherwise asymptomatic patient.2 Esophageal dilation in patients with head and neck cancer is frequently undertaken to improve dysphagia, and up to 33% of patients may have an esophageal stricture visible on barium esophagogram.3 In the patient who has undergone radiation therapy, microperforations that may accompany esophagoscopy can have severe implications. Transient bacteremia associated with esophagoscopy with dilation has been estimated to occur in 45% to 100% of procedures4; however, there is no current consensus data regarding the use of perioperative antibiotics in the irradiated patient undergoing this procedure. The role of antibiotic prophylaxis in this patient population is also under discussion at this institution, and we wholeheartedly agree with the need for further study of the risk to benefit ratio of antibiotic prophylaxis in this setting.
D’Souza JN, Cognetti D. Cervical Osteomyelitis After Pharyngeal Surgical Manipulation—Reply. JAMA Otolaryngol Head Neck Surg. 2016;142(11):1130-1131. doi:10.1001/jamaoto.2016.1840