Acute airway obstruction is a rare presentation of megaoesophagus. Megaoesophagus is commonly caused by achalasia; however, we present a case of megaoesophagus caused by idiopathic dysmotility disorder. Decompression with a wide bore nasogastric tube avoided a scenario of difficult intubation or emergency front of neck access

Key points: 1. In selected patients, biopsies of oropharyngeal lesions including the tonsils can be performed under local anaesthetic safely. 2. The technique described was found to be well tolerated by the patients and there were no adverse outcomes. 3. Performing these biopsies under local anaesthetic eliminates the morbidity associated with general anaesthesia. 4. Performing these biopsies under local anaesthetic increases operating room availability which is particularly important in the current economic climate and considering the covid-19 pandemic. 5. Performing these biopsies under local anaesthetic is thought to reduce the time from initial consultation to reaching a decision regarding treatment.