Flexible Fiberoptic Laryngoscopy Research Articles

Consideration of Hyoid Variability in the Diagnostic Workup of Fishbone Foreign Body Aspiration.

Fishbone foreign body (FFB) can lodge in the upper respiratory or gastrointestinal tracts and frequently cause discomfort. While FFBs are common, variations in the hyoid may present radiographically similarly. The authors present a case in which a 32-year-old woman presented with pain in the right neck with a globus sensation after eating fish. Examination, including flexible fiberoptic laryngoscopy, did not reveal a foreign body. Given the patients' persistent symptoms, a noncontrast computed tomography was performed, demonstrating a radiopaque body superior to the right lateral hyoid bone, consistent with FFB. Direct examination under anesthesia was performed, and no FFB was noted. A reassessment of the imaging suggested a likely aberrant hyoid bone. The authors report this case to remind clinicians that while rare, aberrant hyoid variants may mimic FFB. The authors also review the imaging findings of aberrant hyoid variants in this report, as recognition of hyoid variability can mitigate unnecessary intervention.

Role of flexible fiberoptic nasopharyngolaryngoscopy and indirect laryngoscopy in the diagnosis of laryngopharyngeal pathologies

Background: Visualization of the larynx and pharynx is essential to diagnose and treat pathologies, and to prognosticate. This can be done by using indirect laryngoscopy, rigid and flexible endoscopy, and direct laryngoscopy. The main purpose of the article was to assess the profile of laryngopharyngeal pathologies diagnosed by flexible fiberoptic nasopharyngolaryngoscopy and indirect laryngoscopy in patients with laryngopharyngeal symptoms and to estimate the level of agreement between flexible fiberoptic nasopharyngolaryngoscopy and indirect laryngoscopy for selected laryngopharyngeal conditions like vocal nodule, vocal cord polyp, Reinke’s edema, hypopharyngeal growth, vocal cord palsy, vocal cord growth. An Independent t-test and chi-square test were used to analyze the results. Statistical package for the social sciences (SPSS) version 20 was used for statistical analysis. Methods: In this descriptive cross-sectional study, 101 patients with laryngopharyngeal symptoms were subjected to both indirect laryngoscopy and flexible fiberoptic nasopharyngolaryngoscopy. The structures visualized, pathologies detected, time taken and discomfort levels were statistically analyzed. Results: In our study, we found that laryngopharyngeal symptoms were more common among the 61 to 70 years age group. The majority of them were males. The majority of them were retired employees. The most common presenting complaint was difficulty in swallowing, followed by globus sensation and voice change. All structures were visualized by flexible fiberoptic nasopharyngolaryngoscopy. Whereas, in indirect laryngoscopy, some structures were visualized and some were not. Pyriform fossa apex and post-cricoid region were not visualized for all patients with indirect laryngoscopy. Laryngopharyngeal reflux was the most common pathology detected. There is no significant difference between IDL and FOL in site, subsite, and clinical appearance of the pathology detected. There is a significant difference between IDL and FOL in time taken (FOL has a higher mean) and discomfort levels (IDL has a higher mean). Conclusions: Though indirect laryngoscopy is cost-effective in terms of investment, the time taken for the procedure is also less, flexible fiberoptic laryngoscopy is considered superior because it can visualize all structures and can detect pathologies early in their stage so that the patient gets treatment early which can alter the prognosis.

Position paper of diagnosis and treatment of post-extubation laryngitis in children: a multidisciplinary expert-based opinion

ObjectivesTo make recommendations on the diagnosis and treatment of post-extubation laryngitis (PEL) in children with or without other comorbidities. MethodsA three-iterative modified Delphi method was applied. Specialists were recruited representing pediatric otolaryngologists, pediatric and neonatal intensivists. Questions and statements approached topics encompassing definition, diagnosis, endoscopic airway evaluation, risk factors, comorbidities, management, and follow-up. A consensus was defined as a supermajority >70%. ResultsStridor was considered the most frequent symptom and airway endoscopy was recommended for definitive diagnosis. Gastroesophageal reflux and previous history of intubation were considered risk factors. Specific length of intubation did not achieve a consensus as a risk factor. Systemic corticosteroids should be part of the medical treatment and dexamethasone was the drug of choice. No consensus was achieved regarding dosage of corticosteroids, although endoscopic findings help defining dosage and length of treatment. Non-invasive ventilation, laryngeal rest, and use of comfort sedation scales were recommended. Indications for microlaryngoscopy and bronchoscopy under anesthesia were symptoms progression or failure to improve after the first 72-h of medical treatment post-extubation, after two failed extubations, and/or suspicion of severe lesions on flexible fiberoptic laryngoscopy. ConclusionsManagement of post-extubation laryngitis is challenging and can be facilitated by a multidisciplinary approach. Airway endoscopy is mandatory and impacts decision-making, although there is no consensus regarding dosage and length of treatment.

Bilateral vocal cord paralysis and airway obstruction during postoperative period after partial glossectomy

Bilateral vocal cord paralysis is a rare complication of endotracheal intubation, causing serious problems. We report a case of bilateral vocal cord paralysis and airway obstruction in the postoperative period after partial glossectomy. A 61-year-old male patient with diabetes mellitus underwent partial glossectomy under general anesthesia. The anesthesia during surgery was uneventful. After extubation, the patient appeared to have airway obstruction and complained of dyspnea. Flexible fiberoptic laryngoscopy was performed immediately, and the patient was diagnosed with bilateral vocal cord paralysis. Therefore, reintubation was performed. The patient was extubated the following day and discharged with incomplete recovery of vocal cord paralysis. The study findings indicate that inappropriate endotracheal tube location and cuff pressure can cause bilateral vocal cord paralysis. The involvement of head position and tongue traction during glossectomy was suggested in this case. Anesthesiologists should be able to consider and manage bilateral vocal cord paralysis in patients with airway obstruction in the postoperative period.

Endoscopic evaluation of neonates with signs of upper airway obstruction in the neonatal unit of a tertiary hospital.

The aim of the study is to evaluate major causes of upper airway obstruction in newborns receiving healthcare at our institution, their method of endoscopic assessment and the rate of complications related to these procedures. This is a case series study of patients from institutional neonatal intensive care unit (NICU) presenting signs of ventilatory dysfunction for whom an endoscopic airway assessment was warranted. Information of interest was collected from medical records according to a Clinical and Endoscopic Assessment Protocol created for the study. The protocol included clinical manifestations needing ENT evaluation, clinical signs of ventilatory dysfunction, comorbidities (pulmonary, cardiac, neurological, and gastrointestinal), examination method (airway endoscopy under general anesthesia or awake), exam complications, and final diagnosis. One hundred sixty-nine newborn patients who underwent airway endoscopy (awake bedside flexible fiberoptic laryngoscopy (FFL) or direct laryngoscopy and bronchoscopy (DLB) in the surgical ward) were included. Thirty-nine patients (23.07%) underwent bedside FFL. For the remaining 130 who underwent DLB under general anesthesia, the median procedure time was 30 min (20-44). Only 9 (5.32%) patients presented complications: desaturation (4), laryngospasm without desaturation with spontaneous resolution (2), apnea with resolution after stimulation (1), seizures (1), nasal bleeding (1). The most frequent diagnoses found were glossoptosis, posterior laryngeal edema, and laryngomalacia. This retrospective case series describes the prevalence of different pathologies that cause upper airway obstruction in neonates. Airway endoscopy seems an effective and safe diagnostic tool in neonatal airway obstruction. Glossoptosis was the most prevalent cause of obstruction in our center.

Vocal Cord Monitoring by Flexible Fiberoptic Laryngoscopy During Thyroid Radiofrequency Ablation.

Introduction: Thermal injury to recurrent laryngeal nerve (RLN) during radiofrequency ablation (RFA) can produce temporary or permanent vocal cord paralysis.1 Hydrodissection with cold 5% glucose of "danger triangle" protects RLN during RFA.2 When RFA is performed under local anesthesia, RLN function is monitored by patients producing vocal sounds.3 Large lesions requiring longer RFAs warrant general sedation where voice cannot be assessed, therefore, an additional technique for RLN protection is advisable. Observation of passive symmetrical vocal cord movements during breathing by laryngeal ultrasonography is useful in assessing vocal cord function4; however, flexible-fiberoptic fibrolaringoscopy (FFL) is gold standard for assessing vocal cord movements,5 anticipating potential RLN damage. We report FFL monitoring during RFA under general sedation on a large thyroid nodule. FFL during RFA may detect RLN irritation and dysfunction if asymmetry in passive vocal cord movements is noted. Should asymmetry appear, RFA operator stops delivering energy and repositions electrode needle. Materials and Methods: Thyroid function tests, blood glucose, creatinine, transaminase, International-Normalized-Ratio, and electrocardiogram were performed. Operating room (OR) layout created sufficient space for ear-nose-throat (ENT) and RFA operators. An examination with a fiberscope camera demonstrated normal vocal cord adduction during phonation and abduction during breathing. The procedure was assisted by an anesthetist administering fentanyl 50 mcg, midazolam 1.5 to 5.0 mg, and propofol infusion 2 mg/(kg·h). General sedation was conducted so that reflexes were attenuated but still observable. Incorporating in OR by an anesthetist who performs general sedation reduces side effects and complications.6 Ultrasonography showed a 34-mL right lobe nodule abutting on the RLN area. After sedation with propofol, the ENT specialist inserted an endoscope until the glottic plane. During calm breathing, vocal cords moved symmetrically. After obtaining anterior nodule hydrodissection from strap and sternocleidomastoid muscles with 10 mL of 2% lidocaine, posterior hydrodissection was achieved by ultrasound-guided administration of 30 mL of 5% cold glucose. Anterior and posterior hydrodissections merged, separating nodule from neck structures. The radiofrequency electrode needle was then inserted into the nodule, initially positioned in inferior nodule portion adjacent to danger triangle previously isolated by hydrodissection. Initial power was 30 watts. Moving-shot technique was used. Results: FFL was performed throughout thyroid RFA. Symmetric vocal cord movements during breathing demonstrated no RLN irritation. FFL monitoring allowed observation of natural reflexive phenomena, including swallowing. Complete nodule ablation was achieved. FFL performed post-RFA confirmed normal vocal cord motility. Conclusions: We report the first-time use of FFL for vocal cord monitoring during RFA. FFL was easily performed by the ENT specialist and well tolerated by the patient. Avoiding danger triangle and precise RFA needle positioning is key in preventing RLN injury. Benign nodules regrow if total ablation is not achieved7 and some authors propose additional procedures to complete ablation8 that obviously incurs costs. Total RFA nodule ablation-assisted FFL monitoring eliminates the need for repetitive RFAs, thus reducing overall treatment costs. Finally, FFL monitoring does not prolong procedure, as it is performed simultaneously with RFA. FFL is a valid technique when used in conjunction with hydrodissection to further prevent RLN thermal injury during RFA, especially indicated for large thyroid nodule ablation and professional voice users. Patient Consent and Permission: The patient provided written consent for FFL monitoring and permission to use his portrayals and ultrasonographic images during RFA. The study was completed in accordance with the Declaration of Helsinki as revised in 2013. Adherence to institutional review board protocols was granted. Disclaimer: Representation of any instrumentation within the video does not indicate any endorsement of the product and/or company by the publisher, the American Thyroid Association, or the authors. No competing financial interests exist. Runtime of video: 9 mins 39 secs.

A New Approach for Diagnosis and Surveillance of Infantile Subglottic Hemangioma in the Era of Propranolol Use: A Case Series.

To report our institutional experience in diagnosing and surveilling patients with infantile subglottic hemangioma (SGH) using in-office flexible fiberoptic laryngoscopy (FFL) with video technology, without requiring operative endoscopy in the era of propranolol use. A retrospective case series was conducted on 4 children diagnosed with SGH between 2016 and 2022 at our institution. Awake FFL with video technology provided adequate visualization of SGH lesions for diagnosis, without any complications. Serial examinations of the airway were performed in the outpatient setting and each SGH gradually regressed, with marked improvement in respiratory symptoms within 48 hours of oral propranolol initiation. Our findings showed that in select patients, FFL with video technology can successfully identify SGH lesions without general anesthesia exposure. FFL may be used as a low-risk screening tool for propranolol therapy initiation in some patients, but operative endoscopy should remain the gold standard procedure for others. By utilizing FFL in this manner, it is possible to diagnose SGH lesions and start propranolol therapy without exposing all patients to the risks of operative endoscopy.

Pharyngeal Fish Hook Impaction: Case Report and Literature Review.

Foreign bodies, particularly fish bones, in the hypopharynx and cervical esophagus are a common complaint. A swallowed foreign body can be embedded in the tonsil, the base of the tongue, the pyriform fossae, or any region of the upper esophagus. A 70-year-old woman presented with persistent left-sided pharyngeal pain with the sensation of a foreign body for 10 days. She felt a sudden sharp pain in her pharynx while eating a fish head 10 days before the presentation. On examination, an elderly woman was found in painful distress. Flexible fiberoptic laryngoscopy revealed a pool of saliva in the pyriform fossae and a diagnosis of a foreign body in the esophagus was suspected. She was planned for direct laryngoscopy, left (lateral/external) pharyngotomy, and removal of foreign bodies under fluoroscopic guidance of the C-arm. A metallic fish hook that hung over the greater left horn, buried in the neck muscles, was found during the surgery and was extracted. The patient did well postoperatively and was discharged from the clinic. Foreign bodies, particularly fish bones, in the hypopharynx and cervical esophagus are a common complaint, particularly in the African setting.

Study to establish fiberoptic laryngoscopy as a diagnostic and investigation tool for laryngotracheal stenosis and to use the same for prognosis of the disease: retrospective analysis

Background: Laryngotracheal stenosis is a common benign condition of airway obstruction in both the pediatric and adult age group. This could either be acquired or congenital, in which there is narrowing of either the portions of the larynx or trachea making it difficult to breathe. This condition can be managed by several operative and endoscopic procedures. Flexible fiber optic laryngoscope is an excellent tool in the diagnostic investigation of laryngotracheal stenosis. Methods: This is a retrospective study that was done with data collected from the medical records department of patients diagnosed with laryngotracheal stenosis in a tertiary care hospital in the last 10 years. Results: A total of 22 patients who underwent FFL exam were taken for this retrospective study and the results were analyzed. Conclusions: This study proves that Fiberoptic laryngoscopy is a single modality diagnostic tool, which is useful in diagnosing, and localizing stenotic lesions in the Laryngotracheal region. It is cheap, less invasive and trained Otolaryngologist can perform this as an outpatient procedure. This therefore reduces the exposure to harmful radiation caused by repeated computed tomography scans.

The Effectiveness of Ultraviolet Smart D60 in Reducing Contamination of Flexible Fiberoptic Laryngoscopes.

To compare the effectiveness of disinfection protocols utilizing a ultraviolet (UV) Smart D60 light system with Impelux™ technology with a standard Cidex ortho-phthalaldehyde (OPA) disinfection protocol for cleaning flexible fiberoptic laryngoscopes (FFLs). Two hundred FFLs were tested for bacterial contamination after routine use, and another 200 FFLs were tested after disinfection with one of four methods: enzymatic detergent plus Cidex OPA (standard), enzymatic detergent plus UV Smart D60, microfiber cloth plus UV Smart D60, and nonsterile wipe plus UV Smart D60. Pre- and post-disinfection microbial burden levels and positive culture rates were compared using Kruskal-Wallis ANOVA and Fisher's two-sided exact, respectively. After routine use, approximately 56% (112/200) of FFLs were contaminated, with an average contamination level of 9,973.7 ± 70,136.3 CFU/mL. The standard reprocessing method showed no positive cultures. The enzymatic plus UV, microfiber plus UV, and nonsterile wipe plus UV methods yielded contamination rates of 4% (2/50), 6% (3/50), and 12% (6/50), respectively, with no significant differences among the treatment groups (p > 0.05). The pre-disinfection microbial burden levels decreased significantly after each disinfection technique (p < 0.001). The average microbial burden recovered after enzymatic plus UV, microfiber plus UV, and nonsterile wipe plus UV were 0.40 CFU/mL ± 2, 0.60 CFU/mL ± 2.4, and 12.2 CFU/mL ± 69.5, respectively, with no significant difference among the treatment groups (p > 0.05). Micrococcus species (53.8%) were most frequently isolated, and no high-concern organisms were recovered. Disinfection protocols utilizing UV Smart D60 were as effective as the standard chemical disinfection protocol using Cidex OPA. N/A Laryngoscope, 2023.

Cribriform adenocarcinoma of the minor salivary glands: a case report

BackgroundPolymorphous adenocarcinoma is the third most common malignant salivary gland tumor. Within polymorphous adenocarcinoma, cribriform adenocarcinoma of salivary glands is a rare subtype and resembles papillary thyroid carcinoma histopathologically. Diagnostically, cribriform adenocarcinoma of salivary glands is challenging for pathologists and surgeons alike as initial presentation and cytologic nuclear features can be easily confused with papillary thyroid carcinoma arising from a thyroglossal duct remnant or lingual thyroid.Case presentationA healthy 64-year-old Caucasian woman presented to a community otolaryngologist with a 4-year history of progressive postnasal drip, globus sensation, and eventual dysphonia. Flexible fiberoptic laryngoscopy showed a large, smooth, vallecular lesion filling the oropharynx. Computed tomography imaging of the neck showed a rounded heterogeneous mass centered within the right aspect of the oropharynx measuring 4.2 × 4.4 × 4.5 cm. Fine needle aspiration biopsy was suspicious for papillary carcinoma due to microscopic findings of malignant cells, nuclear grooves, and a powdery chromatin pattern. In the operating room, the tumor was resected en bloc using a lateral pharyngotomy approach with partial resection of the right lateral hyoid. A limited cervical lymphadenectomy was performed to facilitate the lateral pharyngotomy approach and two out of three lymph nodes demonstrated regional metastatic disease. Nuclear grooves, nuclear membrane notching, and occasional intranuclear pseudoinclusions were identified, which are overlapping histopathological characteristics of papillary thyroid carcinoma and cribriform adenocarcinoma of salivary glands. It was negative for thyroglobulin and thyroid transcription factor-1, which was in keeping with cribriform adenocarcinoma of salivary glands rather than papillary thyroid carcinoma.ConclusionIt is difficult to distinguish cribriform adenocarcinoma of salivary glands from papillary thyroid carcinoma solely by cytology, and the distinct characteristics of regional lymph node metastasis coupled with nuanced histologic differences should be emphasized in the evaluation of patients presenting with neck lymphadenopathy and an unknown primary or tongue mass. If sufficient fine needle aspiration biopsy material is available, thyroid transcription factor-1, thyroglobulin, or molecular testing may prove useful in differentiating cribriform adenocarcinoma of salivary glands from papillary thyroid carcinoma. A misdiagnosis of papillary thyroid carcinoma may lead to inappropriate treatment including unnecessary thyroidectomy. Therefore, it is critical for both pathologists and surgeons to be aware of this uncommon entity to avoid misdiagnosis and subsequent mismanagement.

Pain in the neck: Bench press injury.

A 49-year-old man with a history of hepatitis C infection presented to the emergency department with neck pain and hoarseness immediately after a blunt neck injury. He was bench pressing a 100 kg barbell when the safety bar broke. The bar slowly landed on his neck and remained there for a few seconds. On examination, his vital signs were normal except for hypertension, 167/106 mm Hg. His neck was tender to palpation, without swelling or ecchymosis. He had hoarseness, but the airway was patent without stridor. He showed no signs of respiratory distress. Computed tomography (CT) scan showed thyroid cartilage fracture and right arytenoid hematoma (Figure 1). Flexible fiberoptic laryngoscopy performed in the emergency department confirmed a right arytenoid hematoma with intact airway (Figure 2). Platelet count and prothrombin time-international normalized ratio were normal. Due to concerns of an impending airway emergency from the hematoma, he stayed in the observation unit for 12 hours. A second fiberoptic laryngoscopy on the next day showed no enlargement of the hematoma. He was discharged with close follow-up and recovered without any adverse events. Blunt laryngeal trauma is a rare but potentially life-threatening condition often caused by motor vehicle collisions, sport-related injuries, physical assaults, and strangulation. Clinically, it can cause neck pain, hoarseness, dyspnea, stridor, ecchymosis, crepitus, and airway obstruction.1 The first step in management is to assess and, if necessary, secure the airway. CT scan and flexible fiberoptic laryngoscopy are the key diagnostic tests for suspected laryngeal injury.2 A high index of suspicion and judicious use of diagnostic modalities are required as some patients with significant injuries may not have obvious signs of trauma, as in this case. Patients with high-grade injuries may require surgical intervention.3 Early intervention is the key to a good functional outcome.4

The Best Modality to Assess Vocal Fold Mobility in Children: Flexible Fiberoptic Laryngoscopy or Ultrasound?

The LaryngoscopeEarly View Triological Society Best Practice The Best Modality to Assess Vocal Fold Mobility in Children: Flexible Fiberoptic Laryngoscopy or Ultrasound? Claire M. Lawlor MD, Claire M. Lawlor MD orcid.org/0000-0003-0636-6233 Children's National Medical Center, Division of Otolaryngology, Washington, DC, U.S.A.Search for more papers by this authorSukgi S. Choi MD, MBA, Corresponding Author Sukgi S. Choi MD, MBA [email protected] orcid.org/0000-0002-5448-1546 Boston Children's Hospital, Department of Otolaryngology & Communication Enhancement, Boston, Massachusetts, U.S.A. Send correspondence to Sukgi S. Choi, MD, Department of Otolaryngology, Boston Children's Hospital, 300 Longwood Ave BCH3129, Boston, MA 02115, U.S.A. Email: [email protected]Search for more papers by this author Claire M. Lawlor MD, Claire M. Lawlor MD orcid.org/0000-0003-0636-6233 Children's National Medical Center, Division of Otolaryngology, Washington, DC, U.S.A.Search for more papers by this authorSukgi S. Choi MD, MBA, Corresponding Author Sukgi S. Choi MD, MBA [email protected] orcid.org/0000-0002-5448-1546 Boston Children's Hospital, Department of Otolaryngology & Communication Enhancement, Boston, Massachusetts, U.S.A. Send correspondence to Sukgi S. Choi, MD, Department of Otolaryngology, Boston Children's Hospital, 300 Longwood Ave BCH3129, Boston, MA 02115, U.S.A. Email: [email protected]Search for more papers by this author First published: 30 January 2023 https://doi.org/10.1002/lary.30587 Editor's Note: This Manuscript was accepted for publication on January 07, 2023. The authors have no funding, financial relationships, or conflicts of interest to disclose. Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article. Early ViewOnline Version of Record before inclusion in an issue RelatedInformation

Effect of visual distraction on discomfort score during flexible fiberoptic direct laryngoscopy: a randomized control trial

BackgroundFlexible fiberoptic direct laryngoscopy is the standard technique for evaluating the larynx and hypopharynx and is a routine outpatient procedure performed in ENT. This study aims to find the effect of patients’ own procedure video as a distractor over the discomfort score, during flexible fiberoptic direct laryngoscopy. It can be a cost-effective alternative to local anesthetics and should be included in our routine practice.ResultsThe study included 60 patients undergoing flexible laryngoscopy at a tertiary care hospital. Patients were divided into two groups: group A (those patients who had visualized their procedure video while performing FFODL) and group B (those patients who had not visualized their procedure video while performing FFODL). Visual distraction was involving patients to see their own video while FFODL was being performed. After, the procedure discomfort score was assessed using a visual analog scale. In our study, both groups were comparable in terms of age and gender. The mean discomfort score was significantly reduced in group A as compared to group B (p value 0.003).ConclusionThis study has shown that visual distraction significantly reduced the procedure-specific mean discomfort scores and that it should be practiced routinely to alleviate patient’s anxiousness and fear to go through this procedure and to gain the confidence of patients.

外傷性咽頭後間隙血腫例

Retropharyngeal hematoma is an uncommonly encountered condition. However, early diagnosis and appropriate treatment are important owing to the risk of upper airway obstruction. We report a case of retropharyngeal hematoma that needed surgical drainage. A 73-year-old man receiving anticoagulant therapy sustained injury when he fell to the ground on his face. Cervical CT and MRI showed a retropharyngeal hematoma extending from the retropharyngeal to the superior mediastinal space. Flexible fiberoptic laryngoscopy revealed no airway obstruction. However, on day 10 after the injury, the hematoma was found to have increased in size; although there was no dyspnea at the time, owing to the imminent risk of airway obstruction, we performed surgical drainage of the hematoma with no tracheostomy. We reviewed 43 articles on retropharyngeal hematoma reported in the literature to elucidate the clinical characteristics, treatment, and outcomes of this condition. More than a half of the cases published in these reports received conservative treatment; however, about 30% of the cases eventually required tracheostomy because of airway obstruction.

Evaluation of degree of upper aerodigestive tract obstruction in patients with snoring and obstructive sleep apnea syndrome

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Objectives of the study were to evaluate the degree of obstruction of upper aerodigestive tract in patients with snoring and obstructive sleep apnea syndrome (OSAS) by nasopharyngolaryngoscopy assisted Muller’s maneuver; to evaluate the degree of obstruction of upper aerodigestive tract in patients with snoring and OSAS with imaging technique magnetic resonance imaging (MRI); and to find the association between fibroptic nasopharyngolaryngoscopy assisted Muller’s maneuver (NMM) and sleep MRI.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; Study design was&lt;strong&gt; &lt;/strong&gt;open prospective observational study&lt;strong&gt;. &lt;/strong&gt;30 patients diagnosed with snoring and OSA were included in the study at department of ear, nose and throat (ENT), Command Hospital, Air Force, Bangalore. They underwent detailed clinical evaluation and polysomnography followed by assessment of levels and degree of obstruction of upper aerodigestive tract by flexible fiber optic laryngoscopy (FOL) assisted Mullers maneuver and functional (f) sleep MRI. &lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; 20 patients (66.7%) were diagnosed as obstructive sleep apnea syndrome, 10 patients (33.3%) were snorers by Polysomnography. 27 (90%) patients show moderate to severe collapse at level of the base of tongue, 25 (83.3) patients show moderate to severe collapse at the level of soft palate by flexible FOL assisted Mullers maneuver. 22 (73.4%) patients show a collapse the level of the soft palate, 20 (66.6%) patients show a collapse at the level of the base of tongue by f sleep MRI. In this study, on applying Chi square test there was significant association between soft palate Flexible nasopharyngoscopy with muller’s method and soft palate MRI with Chi square value 35.690, p value &amp;lt;0.001. There was significant association between base of tongue flexible nasopharyngoscopy with Muller’s method and base of tongue sleep MRI with Chi-square value 14.511, and p value &amp;lt;0.005.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; Polysomnography is gold standard test to diagnose OSA. Flexible nasopharyngoscopy with Muller’s method and sleep MRI shows the most common site of upper airway collapse is at the level of the soft palate and the base of tongue.&lt;/p&gt;

Epiglottic Calcification: The Unexplored Relationship with Increasing Rates of Renal Disease

No abstract available. Manuscript truncated after 150 words. To the Editor: In the September 2022 issue the Southwest Journal of Pulmonary Critical Care and Sleep published an interesting article authored by Punatar et al. detailing a case of severe dysphagia that was secondary to isolated epiglottic calcifications seen on computed tomography and flexible fiberoptic laryngoscopy (1). The epiglottis plays a critical role in the prevention of aspiration and coordination of swallowing. Calcifications can severely alter its flexibility and limit oral intake. Isolated calcifications of the epiglottis and sequential dysphagia is not a common entity. With the increasing rates of chronic and end-stage renal disease, this letter is focused on increasing the awareness of extra-osseous manifestations of secondary hyperparathyroidism. Secondary hyperparathyroidism is characterized by adaptive parathyroid gland hyperplasia to increase the production of parathyroid hormone. Etiologies include vitamin D deficiency and chronic kidney disease. Vitamin D deficiency can be seen in about 50% of the world population and chronic …

S2315 Epiglottic Calcification, a Rare a Cause of Dysphagia

Introduction: In consideration of dysphagia, most cases predominate in the oropharyngeal region with the remainder caused primarily by esophageal causes. Lesser known and studied is the development of dysphagia and globus sensation from epiglottic pathology, namely epiglottic calcification. With less than a dozen published cases in literature, very little data exists on identification, diagnosis, and treatment of this known cause of morbidity. Here we present a case of oropharyngeal dysphagia arising from a rare cause, epiglottic calcification. Case Description/Methods: An 81-year-old male with history of aortic stenosis and carotid artery stenosis presented with worsening dysphagia over the course of one month. The patient reported significant dysphagia initially to solids and subsequently to liquids causing a weight loss of over 50 pounds. Physical exam of oropharynx and neck was unremarkable. Bedside swallow evaluation suggested mildly decreased hyolaryngeal movement, but no other significant abnormalities were identified. A Barium swallow study revealed incomplete epiglottic excursion during the pharyngeal phase of swallowing. With gastroenterology consultation, patient underwent evaluation with contrast-enhanced esophagogram that showed severe esophageal dysmotility and reflux. CT of neck demonstrated calcification of epiglottis without epiglottal enlargement, which was ultimately found to be the source of his concern. Via ENT, the patient underwent flexible fiberoptic laryngoscopy, and via gastroenterology, patient underwent EGD with biopsy. Yet, no esophageal or gastric pathology other than epiglottic calcification were identified. As no definitive treatment modality was outlined despite evaluation, patient was changed to a modified diet with ongoing speech and swallow therapy with outpatient follow up (Figure). Discussion: Epiglottic calcification is a rare cause of dysphagia that is poorly understood in its etiology, clinical course and outcomes. With our case, we hope to add to literature a unique presentation and imaging. Furthermore, with our case it is demonstrated that despite consultant recommendations, no clear evaluation process or treatment modality currently exists, lending to further study of this pathology. Currently, diagnosis can be accomplished with radiologic evaluation along with exclusion of other causes; however, no definitive treatments are available for this condition. Although the condition itself is rare, it adds to the differential diagnosis as a cause of significant dysphagia.Figure 1.: Calcification of epiglottis (red arrow) visualized on CT scan.

Consultations for Foreign Bodies in Aerodigestive Tract: Assessment of Diagnostic Modalities.

To evaluate test characteristics of various diagnostic modalities in the workup of foreign body (FB) sensation in the aerodigestive tract. Database containing all inpatient otolaryngology consultations between 2008 and 2020 was used. Cases of FB sensation were identified by documented encounter diagnosis or hospital problem of FB or globus sensation. Variables including basic patient demographics, clinical presentations, diagnostic imaging modalities, procedures, and outpatient follow-up were collected. One hundred and six patients were included in the study. A FB was visualized in 55 patients (52%) and removed in 52 patients (49%); 3 patients had a FB that was visualized initially but not found in the operating room. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were found to be 41%, 50%, 58%, and 33%, respectively, for X-ray (XR); 91%, 61%, 70%, and 87%, respectively, for computed tomography (CT). Sensitivity and NPV were 25% and 57%, respectively, for flexible fiberoptic laryngoscopy (FFL). Seventy-one of 106 patients (67%) underwent invasive interventions during their workup for FBs. Ten out of 11 (91%) chicken bones were found in the digestive tract compared to 7 out of 19 (37%) fishbones (p=0.0046). In patients with history of FB ingestion, CT may be more beneficial than XR as a screening tool for locating foreign bodies and guiding further management. FFL alone is inadequate for ruling out a FB in the aerodigestive tract given FB's high likelihood of being in the esophagus or buried in soft tissue or mucosa. 3 Laryngoscope, 133:1361-1366, 2023.

Woman With Voice Changes and Cough

A 67-year-old woman with longstanding tobacco use presented to the emergency department with a persistent cough, difficulty in phonation worsening over several weeks, hoarseness, and a globus sensation. Her vital signs were normal, but she had audible stridor with an otherwise normal oropharyngeal examination. The emergency physician performed bedside transcutaneous laryngeal ultrasound of the patient’s vocal cords (Figure 1), and the otolaryngologist confirmed the diagnosis with flexible fiberoptic laryngoscopy (Figure 2 and Video E1 [available at http://www.annemergmed.com]).