Causes
The cause of Plummer–Vinson syndrome is unknown; however, genetic factors and nutritional deficiencies may play a role. It is more common in women, particularly in middle age, with a peak age over 50 years. Diagnosis
The following clinical presentations may be used in the diagnosis of this condition. Dizziness
Pallor of the conjunctiva and face
Erythematous oral mucosa with burning sensation
Breathlessness
Atrophic and smooth tongue
Peripheral rhagades around the oral cavityThe following tests are helpful in the diagnosis of Plummer–Vinson syndrome. Lab tests
Complete blood cell counts, peripheral blood smears, and iron studies (e.g., serum iron, total iron-binding capacity, ferritin, and saturation percentage) to confirm iron deficiency, either with or without hypochromic microcytic anemia. Imaging
Barium esophagography and videofluoroscopy will help to detect esophageal webs. Esophagogastroduodenoscopy will enable visual confirmation of esophageal webs. The webs occur due to sub-epithelial fibrosis. |

Prevention
Good nutrition with adequate intake of iron may prevent this disorder. Good nutrition should also include balanced diet and exercise. Treatment
Treatment is primarily aimed at correcting the iron-deficiency anemia. Patients with Plummer–Vinson syndrome should receive iron supplementation in their diet. This may improve dysphagia and pain. If not, the web can be dilated with esophageal bougies during upper endoscopy to allow normal swallowing and passage of food. There is risk of perforation of the esophagus with the use of dilators for treatment. Prognosis
Patients generally respond well to treatment. Iron supplementation usually resolves the anemia, and corrects the glossodynia (tongue pain). Plummer-Vinson syndrome is one of the risk factors for developing squamous cell carcinoma of the oral cavity, esophagus, and hypopharynx.
If the disease is difficult to remove, so that there is an increased risk of residual disease, then removal of involved ossicles in order to fully clear cholesteatoma has generally been regarded as necessary and reasonable. In other words, the aims of cholesteatoma treatment form a hierarchy. The paramount objective is the complete removal of cholesteatoma. The remaining objectives, such as hearing preservation, are subordinate to the need for complete removal of cholesteatoma. This hierarchy of aims has led to the development of a wide range of strategies for the treatment of cholesteatoma. Surgery
The variation in technique in cholesteatoma surgery results from each surgeons judgment whether to retain or remove certain structures housed within the temporal bone in order to facilitate the removal of cholesteatoma. This typically involves some form of mastoidectomy which may or may not involve removing the posterior ear canal wall and the ossicles. Removal of the canal wall facilitates the complete clearance of cholesteatoma from the temporal bone in three ways: 

It removes a large surface onto which cholesteatoma may be adherent;
It removes a barrier behind which the cholesteatoma may be hidden;
It removes an impediment to the introduction of instruments used for the removal of cholesteatoma.Thus removal of the canal wall provides one of the most effective strategies for achieving the primary aim of cholesteatoma surgery, the complete removal of cholesteatoma. However, there is a trade-off, since the functional impact of canal wall removal is also important.