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CASE REPORT
Year : 2016  |  Volume : 6  |  Issue : 1  |  Page : 21-24

Laryngeal injury and subcutaneous emphysema caused by an episode of sneezing: A rare case treated with observation alone


Department of Surgery, Division of Otolaryngology – Head and Neck Surgery, Dalhousie University, Halifax, Canada

Correspondence Address:
David Forner
Otolaryngology Clinic, 3rd Floor, Dickson Building, VG Site, QE II Health Sciences Centre, 5820 University Ave., Halifax, NS B3H 2Y9
Canada
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2230-9748.203889

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Traumatic laryngeal injuries can be life-threatening medical events which often require intervention by otolaryngologists. To our knowledge, this is the fourth case report of laryngeal injury resulting from a sneezing episode, and the first to be treated with observational treatment alone. The following is a case report of a 33-year-old man with subcutaneous emphysema caused by laryngeal injury as a result of a sneezing episode. The patient presented to his local emergency department with anterior neck pain, odynophagia, hoarseness, and trace hemoptysis. The Division of Otolaryngology – Head and Neck Surgery was consulted after an enhanced computerized tomography scan revealed extensive subcutaneous emphysema seemingly centered around the level of the hyoid bone. Nasopharyngoscopy and gastrografin swallow were performed. Nasopharyngoscopy revealed a right vocal cord hematoma extending into the immediate anterior subglottis. Gastrografin swallow revealed no signs of esophageal perforation. The patient was discharged without further medical intervention with follow-up scheduled. Repeat nasopharyngoscopy was performed during follow-up, 6 weeks later and demonstrated complete resolution of the vocal cord hematoma. The patient was noted to have developed significant muscle tension dysphonia on the follow-up visit, likely secondary to defensive laryngeal posturing stemming from the initial injury. He was subsequently referred for voice therapy. We demonstrate the first case of treating an endolaryngeal barotrauma injury as a result of a sneezing episode with observational treatment alone. To the best of our knowledge, only three other case reports of sneezing causing laryngeal injury have been published, all of which necessitated additional medical or surgical interventions, ranging from voice restriction to systemic corticosteroids.


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