The role of fiberoptic nasopharyngoscopy in the management of the acute airway in angioneurotic edema

Abstract

Background: Angioneurotic edema of the upper aerodigestive tract (AEUAT) often challenges the otolaryngologist with the decision of surgical intervention versus observation. Objective: To develop a logical approach to the evaluation and management of the airway in patients with AEUAT, emphasizing fiberoptic examination (FOE) findings. Methods: A computer-based retrospective review of all patients diagnosed with AEUAT was performed. The charts were reviewed for demographics, etiology, medical history, presentation, physical examination, imaging studies, intervention, and outcome. Findings on FOE as well as other covariants were statistically compared. Results: Seventy patients with AEUAT were identified. The etiologies consisted of 24 cases of angiotensin converting enzyme inhibitor use (33%), 10 allergic reactions (17%), 1 hereditary (1.5%), and 35 idiopathic cases (48%). Fourteen patients underwent airway intervention, including 6 tracheotomies and 8 intubations. Of the 14 patients, 5 underwent emergent intervention before fiberoptic examination, 4 had laryngeal edema only, and 5 had both laryngeal and base of tongue edema. No patients with both laryngeal and base of tongue edema were observed. The remaining 52 patients were observed in a monitored setting and required no subsequent intervention. Conclusion: FOE is an invaluable tool in the assessment of the compromised airway in patients with angioneurotic edema. Laryngeal edema alone is an ominous physical finding. When laryngeal and pharyngeal edema are present together, the physician should consider immediate intervention. Our findings indicate that symptoms, including stridor, hoarseness, and dysphagia, do correlate with disease severity; however, they must be confirmed with fiberoptic visualization. Although sound clinical judgment should always be exercised, we present our results in the management of the acute airway in angioneurotic edema.