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21KF-056
Superior laryngeal nerve block for treatment of throat pain and cough following laryngeal herpes zoster
Younghun Jun1, Jinyoung Oh2, Kilhyun Kim3
Department of Anesthesiology and Pain Medicine, Kyungpook national university hospital, School of medicine, Kyungpook national university, Daegu, Republic of Korea1Department of Anesthesiology and Pain Medicine, Kyungpook national university Chilgok hospitalSchool of medicine, Kyungpook national university, Daegu, Republic of Korea2
Case Report
A 52-year-old female with left-sided throat pain and a debilitating cough was referred to the pain management center. Her throat pain occurred 63 days prior to presentation. Two days after the onset of throat pain, the patient noticed a non-productive cough that was easily triggered by speaking and visited a laryngologist. She was a non-smoker with an unremarkable medical history. Chest radiography and blood laboratory tests including leukocyte count, C-reactive protein, and erythrocyte sedimentation rate showed no abnormalities.
Flexible laryngoscopy revealed multiple mucosal eruptions and swelling on the left side of the epiglottis and vallecular and supraglottic areas (Figure 1). The vocal movements were bilaterally normal. A clinical diagnosis of laryngeal herpes zoster was made, and a 7-day treatment with 750 mg famciclovir was initiated. In addition, she was treated with 150 mg pregabalin and 100 mg tramadol daily due to throat pain rated at an intensity of 6-7 on the numerical analog scale (NRS) 0 (no pain) to 10 (worst pain imaginable). However, despite these medications, the patient still complained of throat pain at an intensity of 3-4 on the NRS and cough with a foreign body sensation in the throat.
Her lesion was on the supraglottic area including epiglottis and vocal cords which is innervated by superior laryngeal nerves. Therefore, we performed superior laryngeal nerve under ultrasound guidance as a next step in treatment after obtaining informed consent from the patient. The patient was placed in a supine position with the neck extension. We placed the high-frequency (6-13 Hz) linear probe in the transverse plane between the hyoid bone and the thyroid cartilage to identify the left greater horn of the hyoid bone. When the left greater horn of the hyoid bone was observed, the probe was rotated in a vertical plane. The superior laryngeal nerve on the thyrohyoid membrane just below the greater horn of the hyoid bone was identified (Figure 2).
Immediately after the procedure, the throat pain decreased to 1 on the VAS score, and the cough was greatly improved. Four days after the procedure, the pain had disappeared. In addition, 7 days after the intervention, the cough had completely disappeared. Consent for publication of this case report was obtained from the patient. The patient remained symptom-free at a 3 months follow-up.