Acute subglottic laryngitis (ASL) is an inflammatory condition of the larynx, which causes narrowing of the latter. It predominantly occurs in children and presents with difficulty in breathing, voice changes, and a barking cough.
Presentation
Acute subglottic laryngitis (ASL), sometimes called pseudo-croup, is an infection that is usually seen in children and has a higher prevalence in boys. Most cases are reported at around one and a half years of age. In some literature, infection is only considered to be ASL if the causative organism is a virus [1]. ASL can, however, be bacterial or fungal. Furthermore, other sources of literature distinguish pseudo-croup from croup based on the causative organism, with croup being caused by the Corynebacterium diphtheriae.
The most frequently implicated virus is the parainfluenza virus. Initial viral infection can be followed by bacterial superinfection [2] [3]. The rate of occurrence of ASL may be higher in certain seasons, namely autumn and winter [1]. There are several modes of infection, for example, through airborne organisms, blood or trauma [4]. Some cases of ASL are preceded by other respiratory tract infections. Precipitating factors of ASL include infections, both local and systemic, hypersensitivity reactions, air pollution, cigarette smoke, and foreign bodies.
Symptoms are mainly due to the primary characteristic of ASL, which is narrowing of the trachea in the subglottic region due to inflammation resulting in edema. The extent to which the trachea narrows determines the severity of symptoms. Narrowing of the trachea is made more likely if there is a history of asthma, gastroesophageal reflux disease (GERD), trauma, or preexisting scarring or stenosis [2]. The onset of ASL is rapid and often occurs at night. It is also acute and self-limiting; thus treatment given is supportive.
Respiratory manifestations of the condition include dyspnea, cough, stridor, and hoarseness. Constitutional symptoms may be present, such as fever, cervical lymphadenopathy, loss of appetite, weakness, and restlessness. Cyanosis may also occur due to lack of oxygen. In a few cases, the condition may be life-threatening.
Entire Body System
- Malaise
Type 3 - Recurrent aphtous eczema Recurrent aphtous stomatitis gross small aphtas Etiology of Recurrent aphtous stomatitis Unknown Findings in Recurrent aphtous stomatitis Higher TNF Symtpoms of Recurrent aphtous stomatitis burning pain malaise fever [quizlet.com]
A Streptococcus a patient may present with a sore throat and general malaise. You’ll then have the complete recipe in your recipe box. Hey I’ve been really worried about listeria this whole pregnancy especially. [elmemesser.eu]
ACUTE LARYNGITIS (SIMPLE)- SYMPTOMS• Hoarseness of voice• Discomfort• Pain• Instant paroxysmal cough• General cold• Dryness of throat• Malaise• fever 5. [slideshare.net]
Fever & malaise. 4. There may be respiratory obstruction & stridor in severe cases. 5. [slideplayer.com]
Fatigue and malaise. Chronic laryngitis By definition, any patient with symptoms of acute laryngitis persisting for longer than three weeks should be deemed to have chronic laryngitis. [patient.info]
- Weakness
Constitutional symptoms may be present, such as fever, cervical lymphadenopathy, loss of appetite, weakness, and restlessness. Cyanosis may also occur due to lack of oxygen. In a few cases, the condition may be life-threatening. [symptoma.com]
Laryngitis signs and symptoms can include: Hoarseness Weak voice or voice loss Tickling sensation and rawness of your throat Sore throat Dry throat Dry cough When to see a doctor You can manage most acute cases of laryngitis with self-care steps, such [mayoclinic.org]
In unilateral vocal cord paralysis, the infant's cry is weak and feeble; however, there is usually no respiratory distress. [aafp.org]
Complain of vocal weakness 2. Voice lacks its usual tone and vigor 3. The voice breaks or drops in pitch 4. Examination: vocal cords appear slightly bowed [brainscape.com]
The heart's action is weak and rapid. Accompanying these symptoms there will be dryness of the throat, some pain and difficulty in swallowing, and soreness and tenderness in the tissues of the neck. [operatingmicroscopes.com]
- Pallor
Pallor or cyanosis late danger signs B. [slideplayer.com]
Other warning signs of severe respiratory disease are tachypnea, tachycardia out of proportion to the presence of fever, lethargy, pallor, and hypotonia (decreased muscle tone). [atsu.edu]
Respiratoric
- Hoarseness
Diagnosis Diagnosis is usually made by learning the history of a cold followed by hoarseness. The throat usually appears red and somewhat swollen. [medical-dictionary.thefreedictionary.com]
Talking too much, screaming, constantly clearing your throat, or smoking can make you hoarse. They can also lead to problems such as nodules, polyps, and sores on the vocal cords. [icdlist.com]
As a result, your voice sounds hoarse. In some cases of laryngitis, your voice can become almost undetectable. Laryngitis may be short-lived (acute) or long lasting (chronic). [mayoclinic.org]
"Hoarseness in Adults". Am Fam Physician. 11 (11): 720–728. PMID 29431404. ^ a b Dominguez, L. M.; Simpson, C. B. (December 2015). "Viral laryngitis". [en.wikipedia.org]
- Sore Throat
Symptoms The symptoms of a sore throat include redness of the throat, associated with difficulty in swallowing. [health.ccm.net]
The doctor may also choose to look at the patients throat with a small, Sore Throat Sore throats are generally named for the anatomical site. [elmemesser.eu]
Suspect epiglottitis in children with a sore throat and unusual symptoms (e,g., noisy breathing, drooling or any of the symptoms above). Suspect any patient with a severe sore throat and no evidence of tonsillitis or pharyngitis on examination. [atsu.edu]
| acute sore throat NOS (J02.9)| pharyngitis NOS (J02.9)| rhinitis NOS (J31.0)| sore throat NOS (J02.9)| J04.0 Acute laryngitis Inclusion: Edematous laryngitis (acute)| Laryngitis (acute) NOS| Subglottic laryngitis (acute)| Suppurative laryngitis [codelay.com]
The combination of sore throat and dysphagia is a significant clue to the presence of the disease. Indeed, a severe sore throat is almost universal. [ahcmedia.com]
- Inspiratory Stridor
Clinically it presents with protracted barking cough and inspiratory stridor due to mucosal edema resulting in tracheal narrowing. Plain radiograph Plain radiographs are not always required, as the diagnosis is often made clinically. [radiopaedia.org]
Viral croup is diagnosed by hoarseness, barking cough, and inspiratory stridor and retractions, which indicate airway obstruction (Table AI-3). [atsu.edu]
Generally, an inspiratory stridor suggests airway obstruction above the glottis while an expiratory stridor is indicative of obstruction in the lower trachea. A biphasic stridor suggests a glottic or subglottic lesion. [aafp.org]
Stridor is a harsh, high-pitched respiratory sound, which is usually inspiratory but can be biphasic and is produced by turbulent airflow; it is not a diagnosis but a sign of upper airway obstruction ( Chapter 366 ). [clinicalgate.com]
The illness is generally quite mild with sore throat, hoarseness, cough, and possibly mild inspiratory stridor. Respiratory distress is rare with the exception of young infants. [virtualpediatrichospital.org]
- Paroxysmal Cough
ACUTE LARYNGITIS (SIMPLE)- SYMPTOMS• Hoarseness of voice• Discomfort• Pain• Instant paroxysmal cough• General cold• Dryness of throat• Malaise• fever 5. [slideshare.net]
Cardiovascular
- Cyanosis
Cyanosis may also occur due to lack of oxygen. In a few cases, the condition may be life-threatening. The diagnosis of acute subglottic laryngitis is made via a clinical examination, taking into account both history and physical examination. [symptoma.com]
A considerable degree of face cyanosis can occur. Body Temperature is slightly elevated, and the general condition is not heavily disturbed. [laryngitisknowledgebase.com]
Blue lips Assessment Questionnaire; Why: certain causes of cyanosis are limited to children such as acute epiglottitis, croup and acute subglottic laryngitis. A disorder simulating croup; especially acute subglottic laryngitis .. [acronymattic.com]
Degree of cyanosis 7. Degree of retraction 8. Overall fatigue Indicate the need to support (croup) 1. RR over 40 2. PR over 160 3. [brainscape.com]
Pallor or cyanosis late danger signs B. [slideplayer.com]
Skin
- Angioedema
| T78.3 Angioneurotic edema Inclusion: Allergic angioedema| Giant urticaria| Quincke's edema| excludes: serum urticaria (T80.6-)| urticaria (L50.-)| Y84.2 Radiological procedure and radiotherapy as the cause of abnormal reaction of the patient, or [codelay.com]
[…] members of the croup syndromes especially spasmotic croup, diphtheria, measles, retropharyngeal abscess, foreign body aspiration, extrinsic airway compression, intraluminal laryngeal obstruction such as cyst or tumor, congenital subglottic stenosis, angioedema [virtualpediatrichospital.org]
[…] entry Normal Decreased Markedly decreased Croup is typically diagnosed based on signs and symptoms. [3] The first step is to exclude other obstructive conditions of the upper airway, especially epiglottitis, an airway foreign body, subglottic stenosis, angioedema [en.wikipedia.org]
- Skin Rash
These include: aching bones or joints raised purple areas under the skin swollen lymph nodes Two people mentioned skin rashes. Campbell J. Riddell N. Burns V. [elmemesser.eu]
Musculoskeletal
- Torticollis
The most common of these complications is airway obstruction. 45,46 Extensive inflammation may can cause an acute inflammatory torticollis. [ahcmedia.com]
Neurologic
- Lethargy
Lethargy or agitation may be a result of hypoxemia. Other warning signs of severe respiratory disease are tachypnea, tachycardia out of proportion to the presence of fever, lethargy, pallor, and hypotonia (decreased muscle tone). [atsu.edu]
- Hyperactivity
In the case of hyperactivity on beta-lactamase antibiotics, treatment with chloramphenicol should be taken into consideration. This antibiotic was used in the past in the treatment of epiglottitis. [czytelniamedyczna.pl]
Workup
The diagnosis of acute subglottic laryngitis is made via a clinical examination, taking into account both history and physical examination. Laboratory studies are not routinely carried out. If there is pus, this can be cultured, and sensitivity determined before antibiotics are administered [5]. Nose and throat swabs may also be taken. A complete blood count (CBC) may be requested if the infection is thought to be bacterial in origin. Other possible laboratory tests are PCR (polymerase chain reaction), lateral flow tests, and immunoprecipitation.
Imaging modalities include laryngoscopy, although this is not mandatory. Laryngoscopy allows visualization of the inflamed airways and may reveal distortion in the symmetry and movement of the same [6]. Laryngoscopy is often done by a specialist. General practitioners may use indirect laryngoscopy. An additional imaging method is videostroboscopy [7]. This is used when presenting symptoms and laryngoscopic results are mismatched [8].
Treatment
Clinical features, diagnosis and treatment. 61. Acute stenosis laryngo-tracheo-bronchitis. Etiology, diagnosis and treatment. 62. Acute subglottic laryngitis. Etiology, clinical features, diagnosis and treatment. 98. Glottic angina. [acronymattic.com]
1.Breathlessness 2.cough 3. unchanged voice Acute subglottic laryngitis Etiology Viral allergic GERD bacterial Acute subglottic laryngitis treatment Treatment in hospital! [quizlet.com]
Treatment of atrophic laryngitis in adults require treatment of the mucosa with the use of aerosol products, which include chymotrypsin. [lesouffleclavie.com]
– In the event of treatment longer than 10 days, decrease doses gradually to avoid adrenal gland failure. – Pregnancy : no contra-indication – Breast-feeding : no contra-indication – Foetal lung maturation: • after 34 weeks of gestation, corticosteroid [medicalguidelines.msf.org]
Prognosis
Croup is usually self-limiting and has a good overall long-term prognosis. [radiopaedia.org]
Rarely, in severe infections such as those with herpes viruses, laryngeal erosion and necrosis may occur. [ 1 ] Prognosis In acute laryngitis, the prognosis is usually excellent. [patient.info]
When properly conducted complex treatment, the prognosis is quite favorable. Abscess of the larynx may develop due to injury of the mucosa and entering into the wound infection, or occur as a complication of phlegmonous laryngitis. [lesouffleclavie.com]
Prognosis Prognosis for laryngitis is excellent. Recovery is complete, and usually occurs within a week's time. Prevention Prevention of laryngitis is the same as for any upper respiratory infections. [medical-dictionary.thefreedictionary.com]
Prognosis. This is a disease of rapid development. It runs a short course of four or five days, the extent and severity of the symptoms varying largely. [operatingmicroscopes.com]
Etiology
Conclusions.Assessing viral etiology of laryngitis allows us to conclude specific peculiarities between etiological, clinical and demographic spread.INTRODUCTION The subglottic obstructive acute laryngitis of the infant and small child has an almost exclusively [essaymonster.net]
They have been divided into the following groups: Group A--196 children with diseases of unknown etiology; Group B--20 children with identified viral infections; and Group C--68 children with allergic reactions. [ncbi.nlm.nih.gov]
Etiology, diagnosis and treatment. 62. Acute subglottic laryngitis. Etiology, clinical features, diagnosis and treatment. 98. Glottic angina. Etiology, clinical features, diagnosis and treatment. 99. [acronymattic.com]
Certain conditions have both an underlying etiology and multiple body system manifestations due to the underlying etiology. [icd10coded.com]
Epidemiology
[…] the detection of the viruses responsible of the subglottic obstructive acute laryngitis in children and the establishment of clinical-etiological and epidemiological correlations. Material and method. [essaymonster.net]
[…] encephalitides Dengue fever, chikungunya and yellow fever Epidemiologiy of viral hepatitis including prevention and prophylaxis Symptoms, signs and laboratory features of viral hepatitis Liver injury in infectious diseases (excluding viral hepatitis) Epidemiologic [wikilectures.eu]
Covered by the phlegm Symptoms 1.Cough 2.hoarseness Acute laryngitis treatment Inhalatory steroids antibiotics mucolytics Acute epiglottitis Bacterial Inflammatory oedema of the epiglottis leading to abscess Acute epiglottitis epidemiology Disease of [quizlet.com]
An epidemiological study on 5—8-year-old children. Eur J Pediatr. 158; 3: 253—257. http://dx.doi.org/10.1007/s004310051062 ; PMid:10094451 6. Sherman CB, Tosteson TD, Tager IB et al. 1990. Early childhood predictors of asthma. [med-expert.com.ua]
Epidemiology Accurate figures regarding acute laryngitis are not available, as the condition often goes unreported. [patient.info]
Pathophysiology
The basic pathophysiology is inflammation of the mucosa lining the vocal folds and larynx. If infection is involved, white cells aggregate to remove infectious material from the area. [patient.info]
The most common bacteria implicated are Staphylococcus aureus, Streptococcus pneumoniae, Hemophilus influenzae, and Moraxella catarrhalis. [4] Pathophysiology [ edit ] The viral infection that causes croup leads to swelling of the larynx, trachea, and [en.wikipedia.org]
Prevention
[…] cellulitis and necrotizing fasciitis Streptococcal tonsillopharyngitis Diphtheria and differential diagnosis of acute tonsillopharyngitis Listerial infections Diseases caused by food-borne enterotoxins ("food poisoning") and botulism Tetanus including prevention [wikilectures.eu]
Immunological and serological determinations, as well as lung function tests markedly facilitate the identification of etiologic factors in ASL and are of considerable help in planning a therapy and preventing any relapse of the disease. [ncbi.nlm.nih.gov]
Prevention Prevention of laryngitis is the same as for any upper respiratory infections. [medical-dictionary.thefreedictionary.com]
PREVENTION OF LARYNGITIS IN ADULTS AND CHILDREN To prevent the development of laryngitis, it is necessary to treat inflammatory diseases (tonsillitis, sinusitis etc.). [lesouffleclavie.com]
Prevention To prevent dryness or irritation to your vocal cords: Don't smoke, and avoid secondhand smoke. Smoke dries your throat and irritates your vocal cords. Limit alcohol and caffeine. These cause you to lose total body water. [mayoclinic.org]
References
- Pucher B, Jonczyk-Potoczna K, Buraczynska-Andrzejewska B, et al. Environmental pollution and parental smoking influence on the appearance of pseudocroup in children. Ann Agric Environ Med. 2013;20(3):580-582.
- Cherry JD. Croup. N Engl J Med. 2008;358(4):384–391.
- Rosekrans JA. Viral croup: current diagnosis and treatment. Mayo Clin Proc. 1998;73(11):1102–1107.
- Wood JM, Athanasiadis T, Allen J. Laryngitis. BMJ. 2014;349:g5827.
- Vaughan CW. Current concepts in otolaryngology: diagnosis and treatment of organic voice disorders. N Engl J Med. 1982;307(14):863-866.
- Ng ML, Gilbert HR, Lerman JW. Some aerodynamic and acoustic characteristics of acute laryngitis. J Voice. 1997;11(3):356-363.
- Shohet JA, Courey MS, Scott MA, Ossoff RH. Value of videostroboscopic parameters in differentiating true vocal fold cysts from polyps. Laryngoscope. 1996;106(1 Pt 1):19-26.
- Schwartz SR, Cohen SM, Dailey SH, et al. Clinical practice guideline: hoarseness (dysphonia). Otolaryngol Head Neck Surg. 2009;141(3 suppl 2):S1-S31.