acute laryngotracheal infections

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Laryngotracheal infectionsBALASUBRAMANIAN THIAGARAJAN

drtbalu's otolaryngology online

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Acute laryngitis

Acute infections involving larynx

Can be bacterial / viral

Part of upper / lower respiratory infections

Smoking / exposure to pollutants – risk factors

Voice abuse / laryngeal trauma. Posterior glottis commonly involved

GERDS


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Etiology

URI

Neck space infections

GERDS

Non specific inflammation (sarcoidosis, Wegner’s granomas)

Allergy

Inhalation of toxic fumes


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Clinical features

Change / loss of voice

Sore throat

Otalgia

Difficulty in swallowing / painful swallow

Tender larynx

Cervical adenopathy

Difficulty in breathing


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Indirect laryngoscopy

Inflammation involving mucosa of supraglottis / glottis / subglottis

Vocal cord reddish & oedematous

Pooling of saliva is there is odynophagia


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Management

Absolute voice rest

Avoidance of irritants / fumes

Avoidance of gargling

Antibiotics reserved only for severe bacterial infections. Moraxella catarrhalis is common. Erythromycin drug of choice


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Acute epiglottitis

Also known as supraglottitis

Epiglottis is commonly affected

Lingual tonsils, aryepiglottic folds and ventricular bands may also be involved

Can involve all age groups

Can progress rapidly in children causing airway obstruction

Hemophilus influenza is the commonest organism involved


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Clinical features

Drooling

Painful swallowing

Voice change

Inflamed epiglottis, aryepiglottic folds, arytenoids and ventricular bands

Cervical adenopathy


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Radiology

Enlarged epiglottis “Thumb sign”

Absence of deep well defined vallecula “Vallecular sign”.


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Complications

Respiratory distress

Epiglottic abscess

Internal jugular vein thrombosis


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Management

If a child should be admitted

Airway compromise – Tracheostomy

Antibiotics – III generation cephalosporins


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Croup

Laryngotracheal bronchitis

“Sore throat with hoarse breathing”

Children 6 months – 3 yrs

Uncommon in adults

Subglottic oedema

Biphasic stridor


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Etiology

Commonly viral

Paramyxovirus, parainfluenza virus Types I and II have been implicated

In adults herpes simplex have been implicated


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Clinical features

Cough

Sore throat

Malaise

Mild fever

Inspiratory stridor


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X-ray chest

Narrowing seen at the level of subglottis

Steeple sign / pencil sign


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Management

Self limiting disease

Patient improves within a day

Completely recovers in 3-4 days

Oxygenation

Steroids

Adrenaline nebulisation


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Score 0 1 2 3 4 5

Inspiratory stridor

- Audible with steth

Audible without steth

Retraction - Mild Moderate Severe

Air entry Normal Decreased

Severely decreased

Cyanosis None With agitation

At rest

Conscious level

altered

Westley score

Maximum – 172-3 mild croup

4-7 moderate croupAbove 8 severe croup


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Thank you

acute laryngotracheal infections

Health & Medicine