Dizziness is often considered to be a condition that is best managed by physicians or otologists. This case report describes an unusual cause of presyncope successfully treated by a laryngologist. The patient in question was a 45-year-old member of the US Army who started to report lightheadedness, tunnel vision and pallor on exercise. An ECG revealed a bradycardia. One of the investigations ordered by cardiology to evaluate this was a CT angiogram of the head and neck. The CT revealed a 2cm soft tissue prominence at the level of the thyroid cartilage involving the right hypopharynx. Nasendoscopy found this to represent a likely venous malformation around the right arytenoid and aryepiglottic fold. A treadmill stress ECG was then performed before and after a superior laryngeal nerve (SLN) block. The initial stress test was terminated early because of presyncopal symptoms, but the subsequent test following SLN blockade was not limited by these symptoms. The lesion was therefore resected endoscopically with a CO2 laser. Histology was consistent with a benign lymphovascular malformation. No presyncopal symptoms occurred on a postoperative stress test and the patient was able to pass his army medical three months after excision. Whilst clearly a highly unusual and rare cause of presyncope, this case perhaps justifies performing a nasendoscopy on patients referred with ‘vertigo’ who in fact turn out to have symptoms more consistent with presyncope. It might just save someone an unnecessary pacemaker.

Laryngocardiac Reflex: A Case Report and Review of the Literature.
Pingree CS, Majors JS, Howard NS, Eller RL.
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Christopher Burgess

Musgrove Park Hospital, Taunton, UK.

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