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Evaluation of ACE-inhibitor Induced Laryngeal Edema Using Fiberoptic Scope: A Case Report

Joya Singh, DO* and Colin Danko, MD *

DOI: https://doi.org/10.21980/J83P9T Issue 7:3 No ratings yet.
Physical exam was initially significant for swelling isolated to the right sided cheek and upper lip. There was no edema to lower lip, uvular swelling, or swelling to the submandibular space. She was speaking full sentences and did not endorse any voice changes. Initial vital signs were as follows: BP 125/77, HR 74, RR 16, and oxygen saturation of 100% on room air. Approximately 40 minutes later, after 125 mg solumedrol intravenous (IV) and 50mg diphenhydramine by mouth, swelling had spread to the entire upper lip and the patient reported spreading to her jaw (Photo 1). Although no jaw or submandibular edema was appreciated on physical exam, a flexible fiberoptic laryngoscope was used to evaluate the patient’s airways given worsening symptoms. Viscous lidocaine was applied intranasally five minutes prior to the procedure. The patient was positioned in a seated position on the stretcher. A flexible fiberoptic laryngoscope was then inserted through the nares and advanced slowly. Laryngoscopy showed diffuse edema of the epiglottis, arytenoids, and ventricular folds (see photos 2-4). Vital signs and respiratory status remained stable both during and after the procedure.
Current IssueENTProceduresVisual EM

Peritonsillar Abscess Simulator: A Low-Cost, High-Fidelity Trainer

Chad R Keller, DO*, Ivanna Nebor, MD*, David Choi, MD, FRCSC*, Kattia Moreno, MD* and Yash J Patil, MD, MPH*

DOI: https://doi.org/10.21980/J85M0B Issue 7:2 No ratings yet.
By the end of this training session, learners will be able to: 1) locate the abscess, 2) perform needle aspiration, and 3) develop dexterity in maneuvering instruments in the small three-dimensional confines of the oral cavity without causing injury to local structures.
ENTInnovationsProcedures

A Case Report of Epiglottitis in an Adult Patient

Savannah Tan, BS*, Kyle Dornhofer, MD*, Allen Yang, MD*, Shadi Lahham, MD, MS*  and Lindsey C Spiegelman, MD*

DOI: https://doi.org/10.21980/J8QM09 Issue 7:1 No ratings yet.
At the time of presentation to the ED, laboratory results were significant for leukocytosis to 11.8 x 109 white blood cells/L and a partial pressure of carbon dioxide of 52 mmHg on venous blood gas. Computed tomography (CT) of the soft tissue of the neck with contrast showed edematous swelling of the epiglottis and aryepiglottic fold with internal foci of gas (blue arrow) and partial effacement of the laryngopharyngeal airway and scattered cervical lymph nodes bilaterally (Figure 1). Findings were consistent with epiglottitis containing nonspecific air. Additionally, the pathognomonic “thumbprint sign” (yellow arrow) was found on lateral x-ray of the neck (Figure 2). The CT findings as shown in figure 3 illustrate lateral view of the swelling of the epiglottis, gas, and blockage of the airway.
ENTVisual EM

A Low-Cost Facial and Dental Nerve Regional Anesthesia Task Trainer

Andrew Eyre, MD, MSHPed*^ and Valerie Dobiesz, MD, MPH*^

DOI: https://doi.org/10.21980/J8RP9Q Issue 6:2 No ratings yet.
By the end of this educational session, learners should be able to: 1) describe and identify relevant anatomy for supra-orbital, infra-orbital, mental, and inferior alveolar nerves and 2) successfully demonstrate supra-orbital, infra-orbital, mental, and inferior alveolar nerve blocks using a partial task trainer.
ENTInnovationsProcedures

Auricular Perichondritis after a “High Ear Piercing:” A Case Report

Diego Federico Craik Tobar, MD* and Adeola Adekunbi Kosoko, MD*

DOI: https://doi.org/10.21980/J8WH16 Issue 6:2 No ratings yet.
On physical examination, there was erythema, swelling, warmth, and general exquisite tenderness of the superior aspect of the left pinna (the outer ear) but excluding the ear canal, lobe, tragus, and crus. There was no facial involvement. There was no fluctuance about the ear and no drainage of fluid. The preauricular lymph nodes were enlarged and tender, but the anterior cervical lymph nodes were not tender. There was no mastoid tenderness, protrusion of the ear, or interruption of the postauricular crease.
ENTInfectious DiseaseVisual EM

Peritonsillar Abscess Model for Ultrasound Diagnosis Using Inexpensive Materials

Mustafa N Rasheed, BS*, Keel E Coleman, MD* and Timothy J Fortuna, MD*

DOI: https://doi.org/10.21980/J86G9P Issue 5:1 No ratings yet.
By the end of this instructional session learners should be able to: 1) identify and discuss the indications, contraindications, and complications associated with peritonsillar abscesses, 2) properly identify and measure a PTA through ultrasound, and 3) competently perform ultrasound-guided peritonsillar abscess drainage on a simulator and remove fluid.
ENTInfectious DiseaseInnovationsProcedures

Case Report: Acute Supraglottitis

Jamie Robin Chu, MD* and Jonathan G Rogg, MD, MBA^

DOI: https://doi.org/10.21980/J8006V Issue 5:1 No ratings yet.
On arrival, radiographs of the neck soft tissues were obtained, which showed a markedly enlarged epiglottic shadow (red arrow) concerning for epiglottitis. A computed tomography scan of the neck soft tissues with contrast was then obtained which revealed edematous mucosal thickening of the oropharynx (blue arrow) and supraglottic larynx (green arrow) including the epiglottis (purple arrow) concerning for acute infectious pharyngitis and supraglottic laryngitis with severe narrowing of the supraglottic laryngeal lumen, as well as associated extensive inflammation and edema of the superficial and deep left neck spaces. The patient’s white blood cell count was elevated to 25.7x109/L with 87% neutrophils. Her rapid strep test was positive. Otolaryngology was consulted and performed a bedside flexible laryngoscopy which showed significant edema of the epiglottis (orange arrow), vocal cords (white arrow), and arytenoids (black arrow), left greater than right. Based on the findings and concern for impending respiratory failure, the patient received an awake fiberoptic intubation by anesthesia at the bedside.
ENTInfectious DiseaseVisual EM

Abdominal Pain with Black Tongue

David A Adler, MD* and Isabel M Algaze Gonzalez, MD^

DOI: https://doi.org/10.21980/J8XS7JIssue 4:1 No ratings yet.
Patient’s tongue had a black discoloration, without elongated filiform papillae. We could not appreciate lymphadenopathy. His abdomen was tender to palpation.
ENTVisual EM

Facial Fracture Induced Periorbital Emphysema

Hamid Ehsani-Nia, DO* and Robert Eisenstein, MD*

DOI: https://doi.org/10.21980/J8F05HIssue 3:4 No ratings yet.
Physical exam showed marked left palpebral subcutaneous crepitus, as well as bulbar and palpebral conjunctival bulging. Visual acuity was normal with intact extraocular movements, and normal pupillary exam. Computed tomography (CT) imaging of the face was obtained and revealed multiple displaced fractures involving the left orbital floor and zygomatic arch associated with moderate periorbital and postseptal extraconal gas, resulting in orbital proptosis.
ENTTraumaVisual EM

Foreign Body in Maxillary Sinus: A Rare Case of Chronic Rhinosinusitis

Richard Barnett, DO* and Meigra Chin, MD*

DOI: https://doi.org/10.21980/J85H09Issue 3:4 No ratings yet.
Computed tomography (CT) sinus with contrast demonstrated complete opacification of left paranasal sinuses and nasal cavity, and a linear radiopacity within the left maxillary sinus consistent with a foreign body.  There were additional left facial subcutaneous radiopaque opacities.
ENTVisual EM
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