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LT J. Hugh Sales, MC, USNR; LCDR Kevin S. Kennedy, MC, USNR

Arch Otolaryngol Head Neck Surg. 1990;116(6):725-727.

Abstract
• Epiglottic dysfunction due to environmental exposure is a well-known entity. The most common causes of epiglottic dysfunction include trauma (thermal, chemical, and blunt), infection, allergy, neoplasm, and neurologic disorders. We report an unusual case of epiglottic dysfunction due to isocyanate inhalation exposure and review the literature concerning this subject. Following inhalation exposure to diphenylmethane diisocyanate, our patient developed persistent repeated airway obstruction during inspiration. Fiberoptic rhinolaryngoscopy showed that the epiglottis obstructed the glottic airway during each inspiratory cycle. The epiglottic dysfunction was also well demonstrated by barium contrast cineradiography. Total epiglottectomy resulted in resolution of the patient's upper airway obstructive symptoms. Histologically, marked inflammatory changes of the epiglottis were noted, including a focal infiltrative pattern, focal fibrosis, edema, and reactive changes.

(Arch Otolaryngol Head Neck Surg. 1990;116:725-727)

Author Affiliations
From the Departments of Otolaryngology—Head and Neck Surgery, Naval Hospital, Portsmouth, Va (Drs Sales and Kennedy), and Eastern Virginia Medical School, Norfolk (Dr Kennedy), and the Department of Surgery, F. Edward Herbert School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Md (Dr Kennedy).

Footnotes
Accepted for publication November 21, 1989.

Presented, in part, at the annual meeting of the Pacific Coast Oto-Ophthalmologic Society, Kauai, Hawaii, June 25, 1989. Winner of the Resident Paper Competition.

The opinions or assertions expressed herein are those of the authors and are not to be construed as official or as reflecting the views of the Department of the Navy or the Department of Defense.

Reprint requests to Department of Otolaryngology—Head and Neck Surgery, Naval Hospital, Portsmouth, VA 23708-5000 (Dr Sales).

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