Otolaryngology - Head & Neck Surgery Supplement - 2020 Official Program Abstracts - P216

P216
Otolaryngology-Head and Neck Surgery 163(1S)
Presentation schedule is subject to change. The Official Program Abstracts supplement does not reflect changes made after August 10, 2020.
included 3 hemorrhages, 6 severe desaturations, 2 patients
with subcutaneous emphysema, 2 tube obstructions, 1 tracheoesophageal fistula, and 1 cardiac arrest. No statistically
significant associations with vent settings or cardiac function
parameters were found.
Conclusions: The proportion of tracheotomy complications
that occur intraoperatively remains low, compared with those
that occur in the postoperative period. These events are rare
enough that no predictive factors were identified. Further
studies with higher power are needed.

Laryngology

Laryngeal Histoplasmosis in the
Immunocompetent Patient
Christine L. Settoon, MD (Presenter); Ashley C. Mays, MD
Objectives: Head and neck manifestations of histoplasmosis
have been reported multiple times in the literature in the setting of the immunocompromised patient. We report a case of
extensive laryngeal involvement in an immunocompetent
patient initially presumed to be carcinoma.
Methods: Case report and literature review. A 58-year-old
African American man with a history of tobacco abuse, alcohol
use, and hypertension initially presented to a community otolaryngology clinic reporting 6 weeks of dysphonia. He reported
mild odynophagia but denied weight loss or immunosuppressant use. Immune workup and HIV testing were negative. The
patient reported a 40-pack-year history of smoking as well as
daily heavy liquor consumption. A computed tomography scan
of the neck found a large supraglottic mass that appeared to
emanate from the left true vocal cord with significant airway
narrowing as well as cervical lymphadenopathy. A flexible
fiber-optic laryngoscopy was performed in the clinic which
confirmed bulky supraglottic edema with crusting over the
laryngeal inlet. He was subsequently brought to the operating
room for direct laryngoscopy with biopsy. Final pathology of
the right arytenoid specimen returned positive for histoplasma.
The patient was treated as an outpatient for a total of 6 months
with oral itraconazole. The patient's dysphonia and laryngeal
examination showed complete resolution at his 6-month follow-up. On literature review, nearly all cases of disseminated
histoplasma infection (acute and subacute) of the larynx and
oropharynx occurred in the immunocompromised setting.
Conclusions: Acute disseminated histoplasmosis involving
the larynx in an immunocompetent patient is a very rare entity,
and it is important for the otolaryngologist to consider and distinguish it from carcinoma to avoid unnecessary morbidity.
Laryngeal Tuberculosis: Case Report
of a Pregnant Female Requiring Awake
Tracheostomy and Comprehensive
Literature Review
Dhruv Sharma, MD (Presenter); Harrison Love;
Xin Zhang, MD; Benjamin P. Anthony, MD
Objectives: Laryngeal tuberculosis (TB) is a rare diagnosis
that occurs in approximately 1% of TB cases. The incidence
has rapidly declined in the past century thanks to global

medical advances. However, the diagnosis is important for otolaryngologists to recognize and consider because of the possibility of laryngeal airway compromise.
Methods: Case report and literature review.
Results: A 22-year-old Hispanic woman at 24 weeks' gestation presented with sore throat, dysphagia, and dysphonia.
Initially, this was attributed to reflux disease. The symptoms progressively worsened, and at 30 weeks of gestation, a diagnosis of
TB was made. Otolaryngology was consulted and laryngoscopy
demonstrated friable swelling of the epiglottis, false vocal folds,
and vocal folds but a patent airway. Antituberculosis medications were begun (except pyrazinamide because of pregnancy),
and she was discharged at 34 weeks' gestation. At 39 weeks'
gestation, she returned with worsening breathing, and there was
worsening of the supraglottic swelling and airway compromise.
Awake tracheostomy was performed followed by a successful
vaginal delivery later that evening. With continued antituberculosis medications, her symptoms improved, and she was
decannulated 2 months after tracheostomy placement. A comprehensive review of the literature regarding laryngeal TB
cases in the United States is also discussed.
Conclusions: It is important for otolaryngologists to recognize the signs and symptoms of laryngeal TB because the
symptoms of dysphonia and dysphagia are common in otolaryngology clinics. Other medical conditions such as pregnancy
can exacerbate TB symptoms. Prompt recognition and accurate diagnosis are paramount in the successful treatment of
patients with airway compromise in laryngeal TB.
Plasma Ablation-Assisted Endoscopic
Supraglottoplasty for Laryngomalacia
Ramandeep S. Virk, MBBS, MS (Presenter); D.N.S. Prakash;
Ramya Rathod; Kanika Arora
Objectives: Laryngomalacia (LM) is the most common cause
of pediatric stridor. The child usually presents with intermittent
high-pitched stridor that worsens during feeds and postural
variation. The cause of the collapse may be short aryepiglottic
folds, flexibility of the immature cartilage tissues, or redundant mucosa over the arytenoids. Up to 20% of these children
will require surgical intervention in the form of supraglottoplasty. Surgical tools evolved from cold instruments to carbon
dioxide laser and microdebriders. We used plasma ablation for
the successful treatment of LM in 10 cases.
Methods: A retrospective study was conducted on
10 patients referred to the otolaryngology department of a tertiary care center in Northern India from 2014 to 2018. Data
analyzed for each patient included age, sex, symptoms, need
for tracheotomy, type, and number of surgical procedures performed and success rate. All patients had undergone plasma
ablation-assisted endoscopic supraglottoplasty (PASSES). For
the procedure, the 4-hand technique was employed, which
was performed using a 0° 4-mm Hopkins nasal endoscope
(Karl Storz), laryngoscope with a Miller blade, and plasma
ablation wand (Smith & Nephew).
Results: Of these 10 patients, 7 were boys and 3 were girls.
The median age was 88.5 days. Feeding difficulties or

Otolaryngology - Head & Neck Surgery Supplement - 2020 Official Program Abstracts

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