n engl j med 364;25 nejm.org june 23, 2011 e55 After undergoing sinus surgery a week earlier, a 77-year-old woman presented to our outpatient clinic for nasal suctioning. Before undergoing the procedure, she received topical analgesia consisting of a mixture of a 4% lidocaine solution and a 1:5000 epinephrine solution. She had no history of drug allergy and had received similar treatments in the past. Moments later, she reported nausea, hoarseness, and fullness in her throat. Fiberoptic laryngoscopy revealed marked mucosal edema of the arytenoid region (Panel A, black arrows), aryepiglottic fold (arrowhead), and posterior wall of the pharynx (white arrows). One hour after the administration of intravenous hydrocortisone, the laryngopharyngeal edema had partially subsided (Panel B). The following day, she was asymptomatic, with evidence of only minor edema of the left arytenoid mucosa. The edema had almost entirely resolved at a 1-week follow-up visit (Panel C).