Airway Obstruction Caused by Mucinous Material Adherent to the Epiglottis in a Patient with a Progressive Neurological Disorder: An Unusual Case of a Condition Mimicking Acquired Laryngomalacia

We herein report the successful management of a condition mimicking acquired laryngomalacia using conservative methods in an elderly man with a progressive neurological disorder. The patient developed stridor and was transferred to the intensive-care unit. Flexible laryngoscopy revealed a collapsed epiglottis during inspiration, as seen in acquired laryngomalacia, with mucinous material firmly adhered to the epiglottis. The stridor resolved after the removal of this material. Pathology revealed keratinized material, suggesting a collection of sputum or epithelial tissue. Thus, flexible laryngoscopy can differentiate the cause of airway obstruction and avoid unnecessary endotracheal intubation in patients with neurological disorders.

[1]  N. Shime,et al.  Repetitive postoperative extubation failure and cardiac arrest due to laryngomalacia after general anesthesia in an elderly patient: a case report , 2017, Journal of Anesthesia.

[2]  T. Cook,et al.  Airway management in the critically ill: the same, but different. , 2016, British journal of anaesthesia.

[3]  H. El-Hakim,et al.  A case of acquired laryngomalacia in an infant, with endoscopy before and after establishing the diagnosis for the first time , 2015, BMJ Case Reports.

[4]  M. Singer,et al.  Admissions with airway emergencies in the ICU at a tertiary referral centre , 2015, Critical Care.

[5]  K. Mackenzie,et al.  Adult-onset laryngomalacia: case reports and review of management , 2014, European Archives of Oto-Rhino-Laryngology.

[6]  O. Barsottini,et al.  Unusual movement disorders in spinocerebellar ataxias. , 2013, Parkinsonism & related disorders.

[7]  J. Benditt,et al.  Pulmonary issues in patients with chronic neuromuscular disease. , 2013, American journal of respiratory and critical care medicine.

[8]  T. Shimohata,et al.  Floppy epiglottis as a contraindication of CPAP in patients with multiple system atrophy , 2011, Neurology.

[9]  M. Sebbane,et al.  An intervention to decrease complications related to endotracheal intubation in the intensive care unit: a prospective, multiple-center study , 2010, Intensive Care Medicine.

[10]  Asako Kobayashi,et al.  [Upper airway obstruction caused by a floppy epiglottis--report of two cases of amyotrophic lateral sclerosis (ALS)]. , 2009, Nihon Jibiinkoka Gakkai kaiho.

[11]  M. Echternach,et al.  [Acquired laryngomalacia of the epiglottis: case report and review of the literature]. , 2008, HNO.

[12]  G. Richter,et al.  The surgical management of laryngomalacia. , 2008, Otolaryngologic clinics of North America.

[13]  Robert T Sataloff,et al.  Vocal fold paresis and paralysis. , 2007, Otolaryngologic clinics of North America.

[14]  Tetsutaro Ozawa,et al.  Daytime hypoxemia, sleep-disordered breathing, and laryngopharyngeal findings in multiple system atrophy. , 2007, Archives of neurology.

[15]  N. Bauman,et al.  Laryngomalacia and Its Treatment , 1999, The Laryngoscope.

[16]  H. Mima,et al.  Acquired laryngomalacia as a cause of airway obstruction immediately after unilateral mouth floor surgery , 1996, Anaesthesia.

[17]  L. Dinardo,et al.  Acquired laryngomalacia: resolution after neurologic recovery. , 1995, Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery.

[18]  P. Woo.  Acquired Laryngomalacia: Epiglottis Prolapse as a Cause of Airway Obstruction , 1992, The Annals of otology, rhinology, and laryngology.

[19]  L. Holinger,et al.  Etiology of Bilateral Abductor Vocal Cord Paralysis , 1976, The Annals of otology, rhinology, and laryngology.

[20]  M. Kawana,et al.  Acquired airway obstruction caused by hypertrophic mucosa of the arytenoids and aryepiglottic folds. , 1996, American journal of otolaryngology.