BACKGROUND AND OBJECTIVES: Acute epiglottitis is a life-threatening condition that can result in airway obstruction. The present study reports clinical features, management and patient outcomes in an acute epiglottitis. SUBJECTS AND METHOD: Included in our retrospective study were 315 patients who were admitted with the diagnosis of acute epiglottitis between January 2006 and July to the department Otolaryngology-Head and Neck surgery, Hallym University Sacred Heart Hospital 2018. The diagnosis of acute epiglottitis was established by confirmation of inflamed epiglottis using laryngoscope or computed tomography. RESULTS: Among 315 patients, 89 cases (28%) and 83 cases (26%) were found in the fifth and fourth decades, respectively. The mean age of patients was 45.0±13.94 years. The male to female ratio was 1.33:1. A total of 75 patients (23.8%) had co-morbidities, with hypertension (13.6%) being the most common. Fever was relatively uncommon, whereas most patients complained of sore throat. Ceftriaxone was the most common empirical antibiotic regimen prescribed and the use of steroids did not affect the length of hospital stay. Nine patients required airway intervention, including eight who underwent endotracheal intubation and one emergency tracheostomy. In patients who need airway intervention, systolic blood pressure, body temperature, respiratory rate, heart rate, white blood cells and the proportion of dyspnea were significantly higher in comparison to the patients without airway intervention. CONCLUSION: Although acute epiglottitis often has nonspecific symptoms, it may lead to sudden dyspnea and unstable vital signs, so an in-depth understanding of this disease is needed.
Airway Obstruction ; Anti-Bacterial Agents ; Blood Pressure ; Body Temperature ; Ceftriaxone ; Clinical Study ; Diagnosis ; Dyspnea ; Emergencies ; Epiglottis ; Epiglottitis ; Female ; Fever ; Heart ; Heart Rate ; Humans ; Hypertension ; Intubation, Intratracheal ; Korea ; Laryngoscopes ; Length of Stay ; Leukocytes ; Male ; Methods ; Neck ; Pharyngitis ; Respiratory Rate ; Retrospective Studies ; Steroids ; Tracheostomy ; Vital Signs

BACKGROUND AND OBJECTIVES: Upper airway obstruction can occur at the soft palate, tongue base, or epiglottis among obstructive sleep apnea (OSA) patients. Detection of these obstruction sites is very important for choosing a treatment modality for OSA. The purpose of this study was to evaluate the obstruction site of OSA patients and its association with mouth opening and head position. SUBJECTS AND METHOD: Forty-eight consecutive patients with suspicion of OSA were enrolled and underwent videofluoroscopy to evaluate the obstruction site, as well as polysomnography. Obstruction site, mouth opening, and head position were evaluated on videofluoroscopy, and their association was analyzed. RESULTS: According to the videofluoroscopy, 47 (97.9%) of 48 patients showed an obstruction in the soft palate, while 24 (50.0%) were located in the tongue base and 14 (29.2%) in the epiglottis. Multiple obstructions were observed in many patients. Mean apnea-hypopnea index was higher among patients with tongue base obstruction (42.3±26.7) compared to those without obstruction (26.4±21.2, p=0.058). However, epiglottis obstruction did not influence apnea-hypopnea index. Mouth opening did not show any association with tongue base obstruction (p=0.564), while head flexion was highly associated (p<0.001). CONCLUSION: Half of patients with OSA have tongue base obstruction, which worsens the apnea-hypopnea index. Head flexion is associated with tongue base obstruction, while mouth opening is not.
Airway Obstruction ; Epiglottis ; Head ; Humans ; Methods ; Mouth ; Palate, Soft ; Polysomnography ; Sleep Apnea, Obstructive ; Tongue

Awake fiberoptic nasotracheal intubation is a useful technique, especially in patients with airway obstruction. It must not only provide sufficient anesthesia, but also maintain spontaneous breathing. We introduce a method to achieve this using a small dose of fentanyl and midazolam in combination with topical anesthesia. The cases of 2 patients (1 male, 1 female) who underwent oral maxillofacial surgery are reported. They received 50 µg of fentanyl 2–3 times (total 2.2–2.3 µg/kg) at intervals of approximately 2 min. Oxygen was administered via a mask at 6 L/min, and 0.5 mg of midazolam was administered 1–4 times (total 0.02–0.05 mg/kg) at intervals of approximately 2 min. A tracheal tube was inserted through the nasal cavity after topical anesthesia was applied to the epiglottis, vocal cords, and into the trachea through the fiberscope channel. All patients were successfully intubated. This is a useful and safe method for awake fiberoptic nasotracheal intubation.
Airway Obstruction ; Anesthesia ; Conscious Sedation ; Epiglottis ; Fentanyl ; Humans ; Intubation ; Male ; Masks ; Methods ; Midazolam ; Nasal Cavity ; Oxygen ; Respiration ; Surgery, Oral ; Trachea ; Vocal Cords

In Korea, small octopus (Octopus minor) and webfoot octopus (Octopus ocellatus) are food items and fatal laryngeal choking due to ingestion of live octopus is not uncommon. We recently encountered two autopsy cases of accidental choking on small octopus and webfoot octopus. Case 1 involved a 58-year-old fisherman who ingested two live webfoot octopuses in his fishing boat and collapsed. He was immediately taken to the hospital but died. During autopsy, one of the webfoot octopuses was found between his pharynx and esophagus; it was obstructing the epiglottis and upper esophagus. His blood alcohol concentration was 0.140%. Case 2 involved a 55-year-old man who ingested an intact body part of a small octopus and was found dead in his house. He had a history of cerebral infarction and angina pectoris. During autopsy, an intact body part of the small octopus was found to be lodged in the laryngeal inlet.
Airway Obstruction ; Angina Pectoris ; Autopsy ; Bays ; Blood Alcohol Content ; Cerebral Infarction ; Eating ; Epiglottis ; Esophagus ; Humans ; Korea ; Larynx ; Middle Aged ; Octopodiformes ; Pharynx ; Ships

Lipomas are benign tumors and most commonly occurs in trunk, upper extremities and lower extremities. About 13–15% of lipomas are located in the head and neck area. However, lipomas of larynx are very rare and only about 100 cases have been reported. Laryngeal lipomas occur mainly in epiglottis, aryepiglottic fold and false vocal cords, which have adipose tissue. Author experienced an unusual presentation of laryngeal lipoma. Tumor seemed to be located in the supraglottis in the preoperative laryngoscopy, but it was found to be located at the free margin of the true vocal cord. To date, only one case has been reported in the world literature. We report this case with a review of the literature.
Adipose Tissue ; Epiglottis ; Head ; Laryngoscopy ; Larynx ; Lipoma ; Lower Extremity ; Neck ; Upper Extremity ; Vocal Cords

OBJECTIVE: This study evaluated the temporal variables of hyolaryngeal movements during normal swallowing using kinematic analysis of the video fluoroscopic swallowing study (VFSS) to present the normal cut-off values of those variables. METHODS: Seventy-five healthy volunteers (17 men, 58 women) without swallowing dysfunctions were recruited to examine the swallowing of 2-ml diluted barium by a VFSS. Kinematic analysis was conducted by digitization of video files for movements of hyolaryngeal structures, including the vocal cords, hyoid bone, and epiglottis during normal swallowing. The time points and duration of hyolaryngeal movements were measured. The time points were the start point, maximal point, and the end point of the LE (Laryngeal Elevation), HE (Hyoid Excursion), and EF (Epiglottic Folding). The durations of LE, HE, and EF were obtained by subtracting the time of the start point from the time of the maximal point. The onset time of LE was defined as the reference time point (0 sec). The upper and lower limits of the 95% confidence interval were adopted as the normal cut-off values for the temporal variables of hyolaryngeal movements after transformation to a normal distribution. If a transformation formula to a normal distribution was not found in a variable, the values of the 2.5–97.5 percentile were adopted. RESULTS: The cut-off values of the maximal and end points of the LE were 0.281 to 0.916 sec, and 0.830 to 2.205 sec, respectively. The cut-off values of the start, maximal and end points of the HE were −0.233 to 0.400 sec, 0.320 to 0.874 sec, and 0.889 to 2.055 sec, respectively. The cut-off values of the start, maximal, and end points of the EF were 0.017 to 0.483 sec, 0.364 to 1.055 sec, and 0.774 to 1.773 sec, respectively. The cut-off values of the duration of LE, HE, and EF were 0.281 to 0.916 sec, 0.258 to 0.767 sec, and 0.255 to 0.787 sec, respectively. CONCLUSION: This study presented the normal cut-off values of temporal variables of hyolaryngeal movements during normal swallowing. This study can serve as a basis for classifying and analyzing the patterns of patients with dysphagia.
Barium ; Deglutition Disorders ; Deglutition* ; Epiglottis ; Healthy Volunteers ; Humans ; Hyoid Bone ; Male ; Vocal Cords

OBJECTIVE: This study was conducted to evaluate the influence of supraglottic swallowing maneuver on swallowing kinematics using kinematic analysis of a videofluoroscopic swallowing study (VFSS). METHOD: Twenty healthy volunteers (10 in a young group ( < 40 years) and 10 in an elderly group (≥60 years)), participated in this study. After structured instruction by a skilled physician, the subjects swallowed 5 ml of diluted barium in the neutral position without any swallowing maneuvers, as well as with supraglottic swallow maneuver under digital videofluoroscopy, three times each. Kinematic analysis was conducted by digitization of video files for movements of hyolaryngeal structures, including the hyoid bone, larynx, arytenoid, and epiglottis. We measured the maximum displacements and velocities of the hyolaryngeal structures during swallowing. RESULT: The most remarkable change in supraglottic swallow was the maximum vertical displacement (mm) of the hyoid bone during swallowing in both groups (11.5±3.34–19.7±6.88 in the young group, P=0.009; 13.4±2.13–22.8±5.35 in the elderly group, P < 0.001). For velocity variables, patterns of change differed between the young and elderly groups. In the young group, the maximum vertical velocities of the larynx and arytenoid were decreased (P < 0.05), but in the elderly group, the maximum 2D velocity of hyoid bone, maximum horizontal and 2D velocity of the larynx and maximum horizontal velocity of the arytenoid were increased (P < 0.05). There were no significant differences in changes between the young and elderly groups. CONCLUSION: This study showed that supraglottic swallow could affect hyolaryngeal movements, particularly vertical hyoid movement, during swallowing. Beneficial kinematic changes in supraglottic swallow were more pronounced in the elderly group. Therefore, supraglottic swallow may contribute to swallowing improvement by enhancing hyolaryngeal movements during swallowing, in addition to laryngeal closure.
Aged ; Barium ; Biomechanical Phenomena ; Deglutition ; Epiglottis ; Healthy Volunteers ; Humans ; Hyoid Bone ; Larynx ; Methods

OBJECTIVE: To investigate the improvement of dysphagia after balloon dilatation and balloon swallowing at the vallecular space with a Foley catheter in stroke patients. METHODS: This study was conducted between May 1, 2012 and December 31, 2015, and involved 30 stroke patients with complaints of difficulty in swallowing. All patients underwent videofluoroscopic swallowing study (VFSS) before and after vallecular ballooning. VFSS was performed with a 4 mL semisolid bolus. For vallecular ballooning, two trainings were performed for at least 10 minutes, including backward stretching of the epiglottis and swallowing of a balloon located in the vallecular space, by checking the movement of the Foley catheter tip in real time using VFSS. RESULTS: After examination of the dysphagia improvement pattern before and after vallecular ballooning, laryngeal elevation (x-axis: pre 2.62±1.51 mm and post 3.54±1.93 mm, p=0.038; y-axis: pre 17.11±4.24 mm and post 22.11±3.46 mm, p=0.036), pharyngeal transit time (pre 5.76±6.61 s and post 4.08±5.49 s, p=0.043), rotation of the epiglottis (pre 53.24°±26.77° and post 32.45°±24.60°, p<0.001), and post-swallow pharyngeal remnant (pre 41.31%±23.77% and post 32.45%±24.60%, p=0.002) showed statistically significant differences. No significant difference was observed in the penetration-aspiration scale score (pre 4.73±1.50 and post 4.46±1.78, p=0.391). CONCLUSION: For stroke patients with dysmotility of the epiglottis and post-swallowing residue, vallecular ballooning can be considered as an alternative method that can be applied without risk of aspiration in dysphagia treatment.
Catheters ; Deglutition ; Deglutition Disorders* ; Dilatation ; Epiglottis ; Fluoroscopy ; Humans ; Methods ; Stroke*

Laryngomalacia is the most common congenital anomaly that causes inspiratory stridor and airway obstruction in the newborn. Symptoms begin to appear after weeks of age, become worse at 4-8 months, improve between 8-12 months, and usually heal naturally at 12-18 months. Despite these common natural processes, the symptoms of the disease can be very diverse and, in severe cases, require surgical treatment. The diagnosis can be made by suspicion of clinical symptoms and direct observation of the larynx with the spontaneous breathing of the child. Typical laryngeal features include omega-shaped epiglottis, retroflexed epiglottis, short aryepiglottic fold, poor visualization of the vocal folds, and edema of the posterior glottis, including inspiratory supra-arytenoid tissue prolapse. In this review, we discuss the classification and treatment based on symptoms and laryngoscopic findings in patients with laryngomalacia.
Airway Obstruction ; Child ; Classification* ; Comorbidity ; Diagnosis ; Edema ; Epiglottis ; Glottis ; Humans ; Infant, Newborn ; Laryngomalacia* ; Larynx ; Prolapse ; Respiration ; Respiratory Sounds ; Vocal Cords

BACKGROUND: Optiscope™ is a semi-rigid fiberscope for endotracheal intubation. A camera attached to the distal end of the stylet shows the laryngeal view through an adjustable LCD-monitor attached at the handle. The aim of this study was to evaluate the learning curve of skilled anesthesiologists in the use of Optiscope™. METHODS: Eighty-patients with normal airways were randomly assigned to four anesthesiologists, who did not have previous experience of intubation with Optiscope™. After induction of general anesthesia, the four investigators performed 20 intubations each, using the Optiscope™. Time to intubation (TTI), number of intubation attempts, and reasons of prolonged TTI were evaluated. RESULTS: The success rate of intubation was 98.8%. The TTI was significantly faster in 16th–20th patients (35.0 s, interquartile range 27.3–41.4) than in the first 10 patients (54.1 s, interquartile range 31.2–75.5) (P = 0.006). All patients after the 16th intubation were intubated at the first attempt. Frequent problems encountered were difficulty in getting the stylet tip under the epiglottis, and mucous secretion obscuring the laryngeal anatomy. CONCLUSIONS: Optiscope™ is an effective device for endotracheal intubation. About 15 intubations in patients with normal airways provided clinically adequate experience to the skilled anesthesiologists. Additional maneuver of airway opening such as jaw thrust and sufficient removal of oral secretion, are suggested to reduce TTI.
Airway Management ; Anesthesia, General ; Epiglottis ; Humans ; Intubation ; Intubation, Intratracheal* ; Jaw ; Laryngoscopes ; Learning Curve* ; Learning* ; Research Personnel