Sinus Node Dysfunction Triggered by Tonsillar Abscess: Effects of Vagal Nerve Compression.

IF 1 Q3 MEDICINE, GENERAL & INTERNAL
Howard Yu, Sahil Zaveri, Michael Schaible, Nabeel Butt, Said Tfaili, Adam S Budzikowski
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Abstract

BACKGROUND Compression of the vagus nerve by a pharyngeal mass is a well-documented condition that can result in sinus node dysfunction (SND). However, there is scarce literature on extrinsic vagal nerve compression from a tonsillar abscess. CASE REPORT A 59-year-old woman with a history of asthma and chronic throat discomfort presented to the Emergency Department with bradycardia, palpitations, and voice changes. Following a shellfish allergy hospitalization, an otolaryngology evaluation revealed an enlarged right tonsil, recommending tonsillectomy, but scheduling challenges persisted. The patient reported mild throat pain, dysphagia, hoarseness, rhinorrhea, and exertional dyspnea and was admitted for the evaluation of peritonsillar mass. She was found to be bradycardic with a heart rate of 47, with an electrocardiogram revealing SND. Albuterol and ipratropium nebulizers, as well as dexamethasone and pantoprazole, were initiated. With this treatment, the patient symptomatically improved with a new heart rate of 68. She was discharged with outpatient appointments, but was unfortunately lost to follow-up. CONCLUSIONS This case reveals sinus node dysfunction resulting from extrinsic vagal nerve compression by a tonsillar abscess. Pressure on the vagus nerve can trigger bradycardia and low blood pressure, possibly due to compensatory overfiring of afferent vagal nerve signals from local mass effect. Early recognition and antibiotic treatment are essential to prevent cardiac complications. Clinicians must remain vigilant for such extrinsic causes, particularly in patients with chronic sore throat and cardiac symptoms. Further research and case reports are needed to deepen our understanding of this rare yet significant association.

扁桃体脓肿引发的窦房结功能障碍:迷走神经压迫的影响。
背景:咽部肿块压迫迷走神经是一种有据可查的疾病,可导致窦房结功能障碍(SND)。然而,有关扁桃体脓肿压迫迷走神经的文献却很少。病例报告 一位 59 岁的妇女因心动过缓、心悸和声音改变到急诊科就诊,她有哮喘和慢性咽喉不适病史。在一次贝类过敏住院治疗后,耳鼻喉科评估发现其右侧扁桃体肿大,建议其进行扁桃体切除术,但排期问题依然存在。患者报告有轻微的咽喉疼痛、吞咽困难、声音嘶哑、鼻出血和用力呼吸困难,入院进行腹膜周围肿块评估。检查发现她心动过缓,心率为 47,心电图显示为 SND。医生开始使用阿布特罗和异丙托溴铵雾化器以及地塞米松和泮托拉唑。经过治疗,患者的症状有所改善,心率恢复到 68。患者出院后接受了门诊治疗,但遗憾的是失去了随访机会。结论 本病例显示,扁桃体脓肿压迫迷走神经导致窦房结功能障碍。迷走神经受压可引发心动过缓和低血压,这可能是由于局部肿块效应导致迷走神经传入信号代偿性过强所致。早期识别和抗生素治疗对预防心脏并发症至关重要。临床医生必须对此类外在原因保持警惕,尤其是对有慢性咽喉炎和心脏症状的患者。我们需要进一步的研究和病例报告来加深对这种罕见但重要的关联性的理解。
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来源期刊
American Journal of Case Reports
American Journal of Case Reports Medicine-Medicine (all)
CiteScore
1.80
自引率
0.00%
发文量
599
期刊介绍: American Journal of Case Reports is an international, peer-reviewed scientific journal that publishes single and series case reports in all medical fields. American Journal of Case Reports is issued on a continuous basis as a primary electronic journal. Print copies of a single article or a set of articles can be ordered on demand.
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