FREDERIC B.ASKINMDWILLIAM H.WESTRAMD
A 2-MONTH-OLD GIRL who was born after 37 weeks of gestation via spontaneous vaginal delivery presented with feeding difficulties, copious nasal mucous discharge, and noisy breathing induced by feeding and sleeping. Her growth curves were normal, and her medical history was otherwise unremarkable. A chest radiograph and a lateral plain radiograph of the neck demonstrated no abnormalities, but bronchoscopy revealed some anterior prolapse of the arytenoid cartilages and some interarytenoid erythema. Polysomnography showed numerous obstructive apneas, hypopneas, and desaturation values to 81%, but during treatment with bilevel positive airway pressure, the hypopneas significantly improved. A concurrent esophageal pH probe demonstrated significant gastroesophageal reflux.
Lansford CD, Bossen EH, Scher RL. Pathology Quiz Case 1. Arch Otolaryngol Head Neck Surg. 2003;129(3):369. doi:10.1001/archotol.129.3.369