Signs and Symptoms of Laryngeal Edema
Laryngeal edema presents with characteristic signs and symptoms of airway compromise including change in voice quality, difficulty swallowing, and progressive difficulty breathing, which require immediate medical attention to prevent life-threatening airway obstruction. 1
Clinical Presentation
Early Signs and Symptoms
- Voice changes: Hoarseness or dysphonia is often the first noticeable symptom 1
- Throat discomfort: Sensation of throat tightness or fullness
- Dysphagia: Difficulty or pain when swallowing 2
- Throat clearing: Frequent attempts to clear the throat
Progressive Signs and Symptoms
- Stridor: Audible high-pitched sound during breathing, particularly during inspiration 3
- Loss of ability to swallow: Progressive worsening of dysphagia 1
- Difficulty breathing: Increasing respiratory distress 1
- Tachypnea: Increased respiratory rate as compensation for airway narrowing 4
- Use of accessory respiratory muscles: Visible neck muscle use during breathing
- Anxiety and agitation: Due to air hunger and hypoxemia
- Cyanosis: In severe cases, indicating significant hypoxemia
Anatomical Considerations
Laryngeal edema can affect different parts of the larynx:
- Supraglottic edema: Can cause posterior displacement of the epiglottis leading to inspiratory obstruction 1
- Glottic edema: Affects the vocal cords directly, causing voice changes and airway narrowing
- Subglottic edema: Particularly dangerous as this is the narrowest part of the adult airway 1
Etiologies with Specific Presentations
Hereditary Angioedema (HAE)
- Recurrent episodes of non-pitting, non-pruritic edema
- Often involves the face, extremities, genitalia, and larynx
- Family history may be present 1
Post-intubation Laryngeal Edema
- Occurs within 24 hours after extubation
- Risk factors include prolonged intubation, female gender, and traumatic intubation 3
- Presents with post-extubation stridor and respiratory distress
Post-surgical Laryngeal Edema
- Common after thyroid surgery, laryngoscopy, and other head/neck procedures
- May be associated with hematoma formation or recurrent laryngeal nerve injury 1
Allergic/Anaphylactic Laryngeal Edema
- Rapid onset following exposure to allergen
- Often accompanied by other systemic signs of anaphylaxis (urticaria, hypotension) 5
Diagnostic Considerations
Direct visualization of the larynx is essential for diagnosis and assessment of severity:
- Indirect laryngoscopy: May reveal erythema, edema of the vocal folds, arytenoids, and epiglottis 1
- Direct laryngoscopy: Gold standard for assessment, can reveal the extent of edema and airway compromise 5
- Flexible nasolaryngoscopy: Less traumatic method for visualization
Warning Signs of Impending Airway Compromise
- Change in voice quality: Progressive worsening of hoarseness 1
- Loss of ability to swallow saliva: Indicates significant edema 1
- Increasing stridor: Especially when audible without a stethoscope
- Decreasing oxygen saturation: Late sign of critical airway compromise
Clinical Pitfalls and Caveats
Delayed recognition: Laryngeal edema can progress rapidly from mild symptoms to complete airway obstruction 1
Misdiagnosis: Symptoms may be mistaken for globus sensation or psychogenic causes; direct laryngoscopy with provocation can help differentiate 5
False reassurance: The absence of rales or other physical findings does not rule out significant laryngeal edema 6
Underestimation of severity: Patients may appear stable before sudden decompensation
Inappropriate treatment: Standard treatments for angioedema like epinephrine, corticosteroids, or antihistamines may not be effective in hereditary angioedema 1
All patients experiencing oropharyngeal or laryngeal edema should be observed in a medical facility capable of performing intubation or tracheostomy if necessary, with close monitoring for signs and symptoms of impending airway closure 1.