Series Editor: Herbert l. Fred, MD

Prepared by Michael Maxwell, MD, Senior Associate Consultant, Department of Emergency Medicine, Mayo Clinic, Jacksonville, Fla

A 73-year-old woman with known vocal cord polyps came to the emergency department complaining of 1 day’s duration of shortness of breath. Examination showed she was alert and without cyanosis, but she did have inspiratory stridor and a hoarse voice. There was no wheezing, the oxygen saturations were normal, and no elevation of the tongue or sublingual induration was evident. The soft palate was symmetric, and the uvula was not swollen or deviated. Through an Olympus LF-GP flexible fiberoptic scope, the base of the tongue, the hypopharynx, the pyriform sinuses, vallecula, aryepiglottic folds, arytenoid space, and epiglottis appeared normal. However, large gelatinous polyps were attached to the true vocal cords, acting in a “ball-valve” fashion (Figure 1). Upon inspiration, the polyps were drawn through the cords, critically narrowing her airway. Emergent surgical intervention was successful (Figure 2).

Points to remember: Respiratory distress with stridor will generally be glottic in origin, unlike in asthma or peripheral airway disease. Fiberoptic airway skills are essential for physicians working in emergency departments.

Diagnosis: Giant laryngeal polyps.