BACKGROUND Foreign body aspiration (FBA) is a life-threatening pediatric emergency, most common in 1-3-year-olds due to immature swallowing reflexes and exploratory oral behaviors. Common aspirated items include nuts, food particles and small toys, presenting with variable symptoms such as cough, dyspnea, wheezing or acute respiratory failure. Delayed diagnosis or improper management causes severe complications like post-obstructive pneumonia, atelectasis, bronchiectasis and irreversible airway stenosis, increasing morbidity and treatment complexity. CASE REPORT A 16-month-old girl was admitted with persistent cough, progressive dyspnea, intermittent fever, hoarseness, and occasional cyanosis that developed 6 days after accidental pine nut ingestion. Initial flexible bronchoscopy at a local hospital failed due to the foreign body's rigid texture and deep impaction in the right lower lobe basilar bronchus. Chest CT confirmed a pine nut shell in the B9/B10 segmental bronchus with surrounding inflammation. She was transferred for combined rigid-flexible bronchoscopy to establish a secure airway and enable precise visualization before holmium laser fragmentation broke the shell into retrievable fragments for complete removal. Two-week follow-up showed symptomatic B9/B10 stenosis, which improved significantly after sequential 3.5 mm and 4.0 mm balloon dilation. Her respiratory symptoms resolved and imaging confirmed restored lobar ventilation. CONCLUSIONS Rigid-flexible bronchoscopy synergy benefits removal of large rigid foreign bodies in sub-main bronchi by combining rigid bronchoscopy's airway security with flexible bronchoscopy's maneuverability and visualization. Holmium laser safely fragments hard foreign bodies with minimal airway trauma, and sequential balloon dilation effectively treats post-FBA stenosis. Individualized application guided by clinical assessment and imaging optimizes pediatric FBA outcomes.

Unilateral vocal fold paralysis secondary to peripheral nerve injury presents limited treatment options and inconsistent outcomes. This protocol describes an electroacupuncture-based cerebral electric field therapy designed to target neuroanatomically relevant pathways through combined scalp, posterior cervical, and anterior neck electroacupuncture. The procedure includes standardized point selection, stimulation parameters, and treatment sequencing, followed by objective functional assessment using laryngoscopy and videofluoroscopic swallowing study. In a representative case, the application of this protocol was associated with observable improvements in voice quality and swallowing function. Patients with unilateral vocal fold paralysis frequently experience hoarseness, dysphagia, aspiration, and reduced laryngeal sensation, leading to substantial functional limitations and decreased quality of life. This protocol demonstrates the feasibility of electroacupuncture-based cerebral electric field therapy as a structured intervention for unilateral vocal fold paralysis and provides a reproducible framework for future clinical exploration. Additional investigation may help clarify its potential role as a supportive therapeutic option. Future controlled studies may further evaluate its clinical effectiveness and applicability.

Anaplastic thyroid carcinoma is a rapidly progressive thyroid malignancy associated with extensive local invasion and limited survival. We describe the case of a 60-year-old man who developed new-onset dysphagia and voice changes in the setting of a thyroid mass. Initial cytology and core sampling were consistent with papillary thyroid carcinoma, yet the patient's accelerating compressive symptoms led to expedited total thyroidectomy. Surgical pathology ultimately demonstrated conventional papillary carcinoma with discrete foci of undifferentiated carcinoma within the same specimen. This case highlights that rapidly progressive compressive symptoms in a patient with cytology-proven conventional papillary thyroid carcinoma may indicate an occult, unsampled anaplastic component, even in the absence of high-risk features on preoperative evaluation. The presence of both differentiated and undifferentiated components broadens the differential considerations regarding tumor evolution and highlights the need for close clinicopathologic correlation. Prompt recognition of alarming symptoms and early multidisciplinary coordination were central to management, particularly to mitigate the risk of airway compromise and to guide timely postoperative systemic therapy.

Silent gastroesophageal reflux disease (GERD) is an atypical form of reflux disease in which patients present predominantly with extra-esophageal manifestations rather than classic symptoms such as heartburn or acid regurgitation. In this form, gastric refluxate may reach the upper aerodigestive tract, leading to laryngeal or respiratory symptoms that are frequently misattributed to infectious or allergic conditions. The absence of typical gastrointestinal complaints often results in delayed diagnosis and repeated ineffective treatments. We report the case of a 27-year-old male who presented with acute dry cough and progressive hoarseness without gastrointestinal symptoms. After excluding infectious and allergic etiologies, and noting a poor response to antitussive and bronchodilator therapies, a presumptive clinical diagnosis was established. Recognition of dietary triggers and rapid symptom resolution following a 4-week empirical trial of proton pump inhibitor therapy-along with symptom recurrence upon temporary discontinuation-supported the diagnosis of silent GERD. This case highlights the importance of considering reflux-related etiologies in patients with unexplained cough and laryngeal symptoms to avoid diagnostic delays and unnecessary empirical treatments.

Mucopolysaccharidosis type II (MPS II; also known as Hunter syndrome) is an X-linked multisystem disorder characterized by glycosaminoglycan (GAG) accumulation. The vast majority of affected individuals are male; on rare occasion heterozygous females manifest findings. Age of onset, disease severity, and rate of progression vary significantly among affected males. In those with early progressive disease, CNS involvement (manifest primarily by progressive cognitive deterioration), progressive airway disease, and cardiac disease usually result in death in the first or second decade of life. In those with slowly progressive disease, the CNS is not (or is minimally) affected, although the effect of GAG accumulation on other organ systems may be early progressive to the same degree as in those who have progressive cognitive decline. Survival into the early adult years with normal intelligence is common in the slowly progressing form of the disease. Additional findings in both forms of MPS II include: short stature; macrocephaly with or without communicating hydrocephalus; macroglossia; hoarse voice; conductive and sensorineural hearing loss; hepatosplenomegaly; dysostosis multiplex; spinal stenosis; and carpal tunnel syndrome.

Extraosseous Ewing's sarcoma (EES) of the larynx is an exceptionally rare malignancy, with very few cases reported in the literature. Its clinical behavior and optimal management remain poorly defined. We report the case of a 14-year-old patient who presented with hoarseness of voice. Imaging and histopathological evaluation confirmed a diagnosis of laryngeal EES. The patient was treated with systemic chemotherapy followed by radiation therapy, resulting in a favorable clinical and radiological response. EES can occur across a broad age range and may demonstrate aggressive local growth and early metastatic potential. Due to the rarity of laryngeal involvement, standardized treatment guidelines are lacking, and management is often extrapolated from Ewing's sarcoma at other sites. This case highlights the aggressive nature of laryngeal EES and underscores the importance of early diagnosis, comprehensive metastatic workup, and a multidisciplinary treatment approach. Additional case reports are needed to define the prognosis better and optimize management strategies.

Guillain-Barré syndrome is an acute inflammatory polyneuropathy characterized by rapidly progressive, symmetric, ascending weakness often triggered by infection or rarely vaccination. Although influenza and Corona Virus Disease-19 vaccines have been more commonly implicated, there are limited reports of Guillain-Barré syndrome following tetanus- toxoid vaccination. We report a case of 12-yearsold male who developed bilateral lower limbs weakness and hoarseness of voice 3 weeks after receiving tetanus toxoid vaccine given after injury. Neurological examination revealed bilateral hypotonia in lower limb. Cerebrospinal fluid analysis showed albuminocytologic dissociation. Nerve conduction studies were consistent with acute inflammatory demyelinating polyradiculoneuropathy. The patient was treated with intravenous immunoglobulin at 0.4 g/kg/day for 5 days and discharged on 10th day of admission. This case highlights a possible temporal association between tetanus toxoid vaccination and Guillain-Barré syndrome, though the causality cannot be definitively established. Further studies are required to clarify this potential link.