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What Causes Breathing Difficulty?
Question: Hey, to start off I'm a 20 year old male from Iceland, 65kg, 175cm and ca 13% bf. Relatively healthy, I've never smoked or consumed alcohol or any drugs for that matter.
At the start of December I started having difficulties breathing in but not out, at first I thought it'd go away quickly but if anything it just got worse. I went to multiple home doctors with no luck, tried asthma inhalers, acid reflux pills and some allergy pills. Then finally at the start of February I got my throat scoped by an ENT doctor and he saw that every time I breathe in my epiglottis starts moving/closing. I've attached a video of this happening. This lead to me having a laser surgery cutting a part of the epiglottis. I've also attached a video of that result below. However as you can see the epiglottis is still going down every time I breathe and I start snoring/gargling whenever I breathe in. I assume the muscles that control the epiglottis think I'm trying to swallow when I breathe in ? I have no idea that's why I've contacted you. Here are a few questions I have.
1. Have you or your colleagues ever seen anything like this ?
2. Do you have any idea what could've caused this ?
3. Do you have any suggestions what I could do or research to fix this ?
4. Would getting another surgery and cutting the epiglottis more be a good idea ?
Videos.
1. Epiglottis before the surgery: https://www.youtube.com/watch?v=jTbINtqldtg&feature=youtu.be
2. Epiglottis 4 days after surgery: https://www.youtube.com/watch?v=8Jf3kuO6ZmA&feature=youtu.be
At the start of December I started having difficulties breathing in but not out, at first I thought it'd go away quickly but if anything it just got worse. I went to multiple home doctors with no luck, tried asthma inhalers, acid reflux pills and some allergy pills. Then finally at the start of February I got my throat scoped by an ENT doctor and he saw that every time I breathe in my epiglottis starts moving/closing. I've attached a video of this happening. This lead to me having a laser surgery cutting a part of the epiglottis. I've also attached a video of that result below. However as you can see the epiglottis is still going down every time I breathe and I start snoring/gargling whenever I breathe in. I assume the muscles that control the epiglottis think I'm trying to swallow when I breathe in ? I have no idea that's why I've contacted you. Here are a few questions I have.
1. Have you or your colleagues ever seen anything like this ?
2. Do you have any idea what could've caused this ?
3. Do you have any suggestions what I could do or research to fix this ?
4. Would getting another surgery and cutting the epiglottis more be a good idea ?
Videos.
1. Epiglottis before the surgery: https://www.youtube.com/watch?v=jTbINtqldtg&feature=youtu.be
2. Epiglottis 4 days after surgery: https://www.youtube.com/watch?v=8Jf3kuO6ZmA&feature=youtu.be
Brief Answer:
Spiglottopexy or 'V' / 'W' shaped excision of the epiglottis.
Detailed Answer:
Hi,
Thank you for your query.
1. This is a rare conditions in adults. This is referred to as paradoxical movement of the epiglottis, flaccid or floppy epiglottis. Paradoxical movement of the vocal cords should be ruled out by fiber-optic laryngoscopy.
2. The cause is unknown. The closest condition is laryngomalacia which is commonly seen in infants, usually after one or two months of age. In most children, this is managed by nursing them in a prone position, adding vitamin D supplementation. Most children recover without surgical management by the age of two years.
3. In very few cases I do various procedures such as epiglottopexy, where the epiglottis is stitched to the base of the tongue (after bolgerization) with a barbed stitch-less suture.
4. In your post-op video, the removal of the epiglottis is inadequate, which is fine as the removal should be done carefully step wise. In the next procedure, a 'V' or 'W' shaped excision of the epiglottis is recommended or an epiglottopexy may also be done.
5. Meanwhile, you can also sleep prone, start treatment for laryngomalacia, get a fiber-optic laryngoscopy done to rule out paradoxical movement of the vocal cords, and check for any drug induced cartilage damage in the past. Laryngeal EMG can be done to check muscle tone. Any acid reflux worsen this condition and should be controlled.
I hope that I have answered your query. If you have any further questions, I will be available to answer them.
Regards.
Spiglottopexy or 'V' / 'W' shaped excision of the epiglottis.
Detailed Answer:
Hi,
Thank you for your query.
1. This is a rare conditions in adults. This is referred to as paradoxical movement of the epiglottis, flaccid or floppy epiglottis. Paradoxical movement of the vocal cords should be ruled out by fiber-optic laryngoscopy.
2. The cause is unknown. The closest condition is laryngomalacia which is commonly seen in infants, usually after one or two months of age. In most children, this is managed by nursing them in a prone position, adding vitamin D supplementation. Most children recover without surgical management by the age of two years.
3. In very few cases I do various procedures such as epiglottopexy, where the epiglottis is stitched to the base of the tongue (after bolgerization) with a barbed stitch-less suture.
4. In your post-op video, the removal of the epiglottis is inadequate, which is fine as the removal should be done carefully step wise. In the next procedure, a 'V' or 'W' shaped excision of the epiglottis is recommended or an epiglottopexy may also be done.
5. Meanwhile, you can also sleep prone, start treatment for laryngomalacia, get a fiber-optic laryngoscopy done to rule out paradoxical movement of the vocal cords, and check for any drug induced cartilage damage in the past. Laryngeal EMG can be done to check muscle tone. Any acid reflux worsen this condition and should be controlled.
I hope that I have answered your query. If you have any further questions, I will be available to answer them.
Regards.
Note: Consult an experienced Otolaryngologist / ENT Specialist online for further follow up on ear, nose, and throat issues - Book a Call now.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Answered by
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