# Sudden upper airway obstruction during catatonia treatment: A case of nasogastric tube syndrome

## TL;DR

A rare case of upper airway obstruction caused by a nasogastric tube in a psychiatric patient is reported, highlighting the importance of monitoring and multidisciplinary care.

## Contribution

This is the first documented case of nasogastric tube syndrome occurring during catatonia treatment.

## Key findings

- A 66-year-old woman with catatonia developed bilateral vocal fold paralysis due to nasogastric tube syndrome.
- Emergency tracheostomy and removal of the nasogastric tube led to recovery of vocal fold mobility.
- The case underscores the need for vigilance and prompt otolaryngology consultation in psychiatric patients with nasogastric tubes.

## Abstract

Nasogastric tube syndrome (NGTS) is a rare yet potentially life‐threatening complication caused by prolonged compression of the laryngeal structures by a nasogastric tube, resulting in bilateral vocal fold paralysis and acute upper airway obstruction. While NGTS has been reported in patients requiring enteral feeding due to conditions such as stroke or impaired consciousness, no cases during the treatment of catatonia have been documented. NGTS remains underrecognized despite common nasogastric use in catatonia.

The patient was a 66‐year‐old woman with probable dementia with Lewy bodies who presented with catatonia characterized by psychomotor retardation. Due to impaired oral intake, a nasogastric tube was inserted for nutritional support. On the 38th day after the tube was inserted, she gradually developed stridor and worsening respiratory distress, followed by paradoxical breathing. Laryngoscopy revealed bilateral abductor vocal fold paralysis accompanied by marked arytenoid edema, and an emergency tracheostomy was performed. CT imaging confirmed arytenoid edema, while brain and cervical imaging revealed no evidence of central or peripheral lesions affecting the vagus or recurrent laryngeal nerves. Based on the clinical course and findings, a diagnosis of NGTS was made. Following removal of the nasogastric tube, vocal fold mobility gradually returned to normal. Her catatonic symptoms improved significantly after a course of electroconvulsive therapy.

This case highlights the potential severity of NGTS in psychiatric settings. In patients with catatonia, who are often unable to communicate their symptoms, careful clinical monitoring is essential. When upper airway symptoms such as stridor or hoarseness arise during nasogastric feeding, NGTS should be considered as a possible cause. A multidisciplinary approach—including prompt consultation with otolaryngology—is crucial to prevent serious complications.