Retroverted epiglottis presenting as a variant of globus pharyngeus

Abstract

We describe a series of four patients who presented with 'high globus pharyngeus', who all had an abnormally curled epiglottis tip touching and indenting the tongue base. The actual incidence of 'curling epiglottis', as well as the potential impact of this variation in persistent globus symptoms, is not known. We therefore describe for the first time a series of patients with this anatomical variant of the epiglottis, each of whom experienced unresolved globus symptoms despite receiving intensive medical treatment. In the literature, the success rate for improvement in symptoms following medical treatment ranges from 68 to 80 per cent. Following CO2 laser partial epiglottectomy, all four patients experienced complete relief of their symptoms. We advocate consideration of this treatment for high globus pharyngeus that fails to respond to conservative treatment, in cases with proven curled epiglottis on endoscopic examination.

Pathophysiology and treatment of patients with globus sensation —from the viewpoint of esophageal motility dysfunction—

“…First, thyroidectomy in patients with thyroid disorder (66) or partial epiglottectomy in selected cases whose retroverted epiglottis made contact with the tongue base (67, 68), were both reported to significantly relieve the globus symptom.…”

Paresthesias of the upper respiratory tract

“…Аномалия развития надгортанника («чрезмерно за-гнутый надгортанник») может стать причиной КГ, вслед-ствие его контакта с основанием языка или задней стен-кой глотки [20].…”

Management of Globus Pharyngeus

“…Agada et al [9] published a small series of patients with globus having “abnormally” retroverted epiglottises. The definition of a retroverted epiglottis is if the tip touches the tongue base when the tongue is protruded.…”

“…In cases where there are anatomical anomalies, the trend seems to be excision of the offending local structure, most often some part of the cartilaginous framework of the larynx [9, 10]. There have been surprisingly no issues with aspiration or voice change following these procedures.…”