Vagal nerve stimulator masquerading as an inhaled foreign body in a child

Description

An 8-year-old girl with a history of cyclin-dependent kinase-like 5 (CDKL5) disorder was presented to the emergency department with a short history of stridor and intermittent respiratory distress following eating a biscuit. She had a background of CDKL5 disorder causing neurodevelopmental delay, including being non-verbal, and refractory epilepsy for which she had received a vagal nerve stimulator (VNS) implanted 2 years prior. On initial examination she was noted to be maintaining her oxygen saturations but with intermittent worsening of her stridor and a barking cough. There was no clear preceding history of an upper respiratory tract infection. Given the concerns regarding a potential inhaled foreign body and only minor improvement with steroids and nebulised adrenaline, she was transferred to theatre for formal microlaryngobronchoscopy.

Microlaryngobronchoscopy confirmed oedema of the glottis (figure 1) and subglottis but no inhaled foreign body. It was noted that there was intermittent laryngospasm affecting...

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