Laryngology Surgery & Voice Care

Medical Advice & Information Related To Your Voice Problems

Reflux Laryngitis with Left Vocal Fold Polyp Add Video

PPW - posterior pharyngeal wall, A - arytenoid complex, E - epiglottis, PC - posterior commissure, arrow - left vocal fold polyp

Posted by Rahmat Omar on February 13, 2016 at 8:01 PM 3063 Views

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Reply Don Setliff
9:27 PM on April 27, 2016 
My comments were meant to be posted under the Khan Academy website video on epiglottis. I apologize, and I don't know how they were diverted to this comment section.
Reply Don Setliff
9:25 PM on April 27, 2016 
A few observations and finer points from an ENT physician of several decades' practice. True laryngeal stridor is typically produced at the level of the vocal cords, not at the level of the epiglottis. Note that one should NOT exclude the diagnosis of epiglottis based on lack of stridor. Stridor is usually a late development in the course of epiglottitis. It can signal impending complete airway obstruction and is therefore an indication for tracheotomy if not relieved immediately by IV steroids. A better name for epiglottis is supraglottitis, since the infection and swelling involve the entire supraglottis, the portion of the larynx that is above the level of the vocal cords. Swelling of the supra glottis without stridor is much more common than that with stridor.

The least invasive, cheapest, fastest, and least risky way to diagnose epiglottis is by the use of a laryngeal mirror and/or fiberoptic laryngoscope, with the latter being inserted through the nose (after preparation with vasoconstrictor solution and topical anesthetic). Epiglottitis patients who are sent to the radiology department, especially kids (who are more likely to obstruct due to a smaller airway), have been known to do exactly that and then die, since radiology departments are not always well equipped to handle airway emergencies. Imaging studies are NOT necessary if you have examined the larynx and already made the diagnosis. Another usual historical finding is ear pain, because the same nerves that innervate the supraglottis also innervate the ear. Another usual physical finding is swelling and tenderness to palpation of the thyroid cartilage.

My experience has been that there is usually dramatic improvement within the first 12-24 hours of the patient's receiving appropriate antibiotics, although a full course is necessary. Steroids are not necessary except in cases with significant airway impingement.