Division of Otorhinolaryngology, Sendai City Hospital, Sendai, Miyagi, Japan.
Tohoku J Exp Med. 2013 May;230(1):43-7. doi: 10.1620/tjem.230.43.
Laryngomalacia is the most common cause of stridor in neonates and infants, where the soft cartilages and tissues surrounding the upper larynx collapse inward during respiration. On the other hand, acquired idiopathic laryngomalacia in adults is quite rare, but should be borne in mind for differential diagnosis of upper airway distress. Allergic factors may cause airway distress, but have not been highlighted previously as the background of laryngomalacia. In this report, we describe two patients with acquired idiopathic laryngomalacia with reference to allergic rhinitis and high serum levels of immunoglobulin E. The first patient was a 16-year-old female who presented with inspiratory stridor and dyspnea due to attachment between the epiglottis and bilateral arytenoids, and the second patient was an 18-year-old male who also presented with inspiratory stridor due to attachment between the epiglottis and posterior pharyngeal wall. The respiratory function of both patients was within the normal range but the inspiratory stridor interfered with daily life. Laryngomicrosurgery was performed in both patients using a CO2 laser to remove the arytenoid mucosa in the first patient, and to remove the tip of the epiglottis in the second. Both patients were followed up while receiving oral anti-allergic agents. Laser supraglottic laryngoplasty to remove the vibrating excess tissue was effective for resolving the symptoms. However, recurrence occurred three times in the first patient, and inferior turbinotomy to improve nasal respiration was useful for diminishing the symptoms.
先天性喉软化症是新生儿和婴儿喘鸣最常见的原因，在上喉的软软骨和组织在呼吸时向内塌陷。另一方面，成人获得性特发性喉软化症相当罕见，但应作为上气道窘迫的鉴别诊断。过敏因素可能导致气道窘迫，但以前并未被强调为喉软化症的背景。在本报告中，我们描述了两例特发性获得性喉软化症患者，参考过敏性鼻炎和高免疫球蛋白 E 血清水平。第一例患者为 16 岁女性，因会厌与双侧杓状软骨粘连而出现吸气性喘鸣和呼吸困难；第二例患者为 18 岁男性，也因会厌与后咽壁粘连而出现吸气性喘鸣。两例患者的呼吸功能均在正常范围内，但吸气性喘鸣干扰了日常生活。两例患者均采用 CO2 激光行喉显微手术，第一例患者切除杓状软骨黏膜，第二例患者切除会厌尖端。两例患者均在接受口服抗过敏药物的同时进行了随访。激光喉上部分切除术切除多余的振动组织对于缓解症状是有效的。然而，第一例患者复发了 3 次，鼻甲切开术改善鼻腔呼吸对减轻症状是有用的。
