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Published on: March 18, 2020
Historical Review and Modern Case of Spontaneous Laryngeal Abscess
Matthew L Rohlfing1, Krystal Kan2, William S Tierney1
1Department of Otolaryngology, Vanderbilt University Medical Center, Nashville, TN, USA.
Objective:
Laryngeal abscesses are rare in the modern antibiotic era. Historically, they were associated with systemic infections including typhoid fever, measles, gonorrhea, syphilis, and tuberculosis. More recent authors have described cases resulting from iatrogenic injury and immunosuppression. This report presents a novel case of laryngeal abscess in the setting of uncontrolled diabetes and a detailed review of modern, reported cases of spontaneous laryngeal abscess.
Methods:
Report of a single case. Also, PubMed was queried for cases of laryngeal abscess since 1985.
Case Report:
A 58-year-old male with poorly controlled diabetes presented with odynophagia, dysphagia, and dyspnea. He had biphasic stridor, and flexible laryngoscopy showed reduced mobility of bilateral vocal folds and narrowed glottic airway. He was taken urgently for awake tracheostomy and microdirect laryngoscopy. Laryngoscopy demonstrated fullness and fluctuance of the right hemilarynx. The abscess cavity was entered endoscopically via paraglottic incision extending into the subglottis. The patient was treated with an 8-week course of ampicillin-sulbactam with resolution of infection.
Results:
Seven additional cases of spontaneous laryngeal abscesses published after 1985 were identified. In total, 6 of 8 had some form of immunodeficiency (75%). The most common presenting symptoms were dysphonia (8/8, 100%), odynophagia (5/8, 62.5%), and dyspnea/stridor (4/8, 50%). All cases were treated with surgical incision and drainage.
Conclusions:
Laryngeal abscesses are rare in the era of modern antibiotics. This review confirms that the majority of recent episodes occurred in the setting of immunodeficiency and are caused by non-tubercular bacteria. These infections are commonly associated with impaired vocal fold mobility which may contribute to dyspnea, stridor, and airway compromise. Surgical intervention is necessary for treatment and culture-directed antimicrobial therapy. Poorly controlled diabetes is a newly described context for development of spontaneous laryngeal abscess.
Insights
Laryngeal abscesses are rare but can occur in patients with uncontrolled diabetes or immunodeficiency. Prompt surgical drainage and antibiotics are crucial for treating these serious airway infections.
Area of Science:
- Otolaryngology
- Infectious Diseases
- Critical Care Medicine
Background:
- Laryngeal abscesses, historically linked to systemic infections, are now rare due to antibiotics.
- Recent cases are often associated with iatrogenic causes or immunosuppression.
Observation:
- A novel case of laryngeal abscess in a patient with uncontrolled diabetes is presented.
- The patient experienced severe airway compromise, including stridor and reduced vocal fold mobility.
- Urgent tracheostomy and endoscopic incision and drainage were performed.
Findings:
- Review of cases since 1985 identified 7 additional spontaneous laryngeal abscesses.
- Immunodeficiency was present in 75% of cases, with common symptoms including dysphonia, odynophagia, and dyspnea.
- All identified cases required surgical incision and drainage.
Implications:
- Laryngeal abscesses in the modern era predominantly affect immunocompromised individuals and are caused by non-tubercular bacteria.
- Impaired vocal fold mobility is a common finding, contributing to airway obstruction.
- Uncontrolled diabetes is a newly identified risk factor; surgical intervention and targeted antibiotics are essential for management.
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