[Upper airway obstruction caused by a floppy epiglottis--report of two cases of amyotrophic lateral sclerosis (ALS)].

The motor system is extensively affected in amyotrophic lateral sclerosis (ALS). Rapid disease progression almost certainly ensures that about half of thsese cases will experience respiratory muscle paralysis to breathe within about five years. We report two cases of ALS involving upper airway obstruction. Fiberoptic laryngoscopy showed floppy epiglottis, tilted posteriorly and horizontally and impacting against the posterior pharyngeal wall during inspiration. Several months later, airway obstruction grew exceedingly worse, and the tilted epiglottis did not return to its vertical resting position. Tracheostomy was conducted during this period. We found that laryngoscopy may be useful in the evaluation of upper airway obstruction, and it may be safer to avoid continuous positive airway pressure.