Suggest treatment for epiglottic prolapse and spastic laryngeal muscles

Posted on Fri, 27 Nov 2015

Question: My son had a balcofen pump replaced on Oct 5 2015, development a large hematoma, and infection. Monday Nov 1, the infected balcofen pump was removed from the rt side and a smaller pump placed on the lt side. My son now has a stridor and breathes 30-50rr/min with nasal flaring, increased WOB. ICU consult 11-5-15 started treating him with steroids and nebulizers, pco2 was WNL,sats are >92% on room air. ENT consult 11-6-15 stop steroids and nebs, and said my son has epiglottis prolapse a congenital disorder. My concern is why did this manifest now he is 22yrs old hx of cp some snoring , previous sleep studies were negative. It sounds like he is having spasms, with pooling of secretions. They want to follow up outpatient ,I am afraid he will tire, these episodes are q3-5mins,. he sounds obstructed. The ENT did a scope states no edema,

Answered by Dr. Abubakar Siddiqh (9 hours later)

Brief Answer:
seems to be spastic laryngeal muscles.

Detailed Answer:
Hi,

I had gone through your question and understand your concerns that your son is having stridor secondary to epiglottic prolapse.

Epiglottic prolapse (laryngomalacia) could be congenital or acquired secondary to previous surgery or after head injury and coma, where injury by intubation, ventilatory support or repeated suctions. The other possibility is spastic laryngeal muscles secondary to multiple sclerosis, cerebral plasy or brain injury.

As such, Baclofen therapy will solve spasticity. Steroids, nebulisations and antibiotics will take care of infections. where as, in establised acquired laryngomalcia (epiglottic prolapse) secondary to trauma needs surgery or CO2 lasers.

In my opinion, it is a difficult task of managing these type of patients at out patient department. There fore, I suggest you to keep him in hospital, till he is free from stridor episodes.

Hope this answers your question, if you have additional questions or follow up questions then please do not hesitate in writing to us. I will be happy to answer your questions.

Wishing you good health.

Above answer was peer-reviewed by : Dr. Sonia Raina