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Acute Subglottic Laryngitis

Subglottic Laryngitis (acute)

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.

Falling
  • It is the most common cause of upper respiratory distress in infants and young children which usually occurs in late fall to early winter 3.[radiopaedia.org]
  • Make sure the child is not in danger of falling! Cool ambient air Cool air reduces swelling of the mucous membranes. Make sure the bedroom temperature is comfortably cool. Medicines Symptoms include fever and a sore throat.[hus.fi]
  • As the infant inhales, the soft larynx falls together, narrowing the inlet and stridor results 3. Swallowing is unaffected Direct examination of laryngmalacia 1. Larynx fall together with inhalation 2. Subglottic area is normal 3.[brainscape.com]
  • Expressed seasonal incidence of false croup, its peak is at the end of fall and beginning of winter. streptococci, staphylococci, pneumococci) is rare and is characterized by more severe.[medicalformat.com]
  • The incidence of croup is higher in boys; it occurs most commonly in the late fall and winter but can occur throughout the year. Recurrences are frequent from 3-6 yr of age and decrease with growth of the airway.[clinicalgate.com]
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]
High Fever
  • Acute Epiglottitis (Supraglottitis) This dramatic, potentially lethal condition is characterized by an acute rapidly progressive and potentially fulminating course of high fever, sore throat, dyspnea, and rapidly progressing respiratory obstruction.[clinicalgate.com]
  • The patient then becomes seriously ill with high fever, toxicity and respiratory distress. External Compression.[aafp.org]
  • The patient often has a high fever and appears quite toxic. This may make the clinician lean toward a clinical diagnosis of epiglottitis.[ahcmedia.com]
Foreign Body Aspiration
  • Videofluoroscopy is useful in the diagnosis of tracheomalacia, foreign body aspiration and vocal cord dysfunction.[aafp.org]
  • General imaging differential considerations include: tracheal foreign body aspiration esophageal foreign body angioneurotic edema epiglottic cysts epiglottitis enlargement of the epiglottis and aryepiglottic folds thumb sign (or omega sign ) usually older[radiopaedia.org]
  • The differential diagnosis of viral croup includes other members of the croup syndromes especially spasmotic croup, diphtheria, measles, retropharyngeal abscess, foreign body aspiration, extrinsic airway compression, intraluminal laryngeal obstruction[virtualpediatrichospital.org]
Pallor
  • They are manifested by progressive sense of suffocation, fear and restlessness on the part of the child, severe shortness of breath, characteristic cough, perioral cyanosis and pallor of the rest of the skin. acute tracheobronchitis, obstructive bronchitis[medicalformat.com]
  • 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]
Cervical Lymphadenopathy
  • 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]
Cough
  • , and irritant induced cough; Pharmacologic management; Unexplained cough; Cough in the pediatric population; and Rhinogenic laryngitis, cough and the unified airway; among others.[books.google.com]
  • It predominantly occurs in children and presents with difficulty in breathing, voice changes, and a barking cough.[symptoma.com]
  • Symptom Chronic or Intermittent dysphonia, vocal strain, foreign body sensation, excessive throat mucus, Postnasal discharge and cough.[gradestack.com]
  • Symptoms of laryngitis include violent cough and hoarseness, episodes of an asphyxiating cough, breathing discomfort, sudden onset of coughing (usually at night).[health.ccm.net]
  • Symptoms hoarse voice hollow, barking cough breathing becomes noisy, difficulty in breathing which is made worse by crying onset usually during the night the most difficult phase lasts 2 to 3 days, cough may persist for over a week fever during the first[hus.fi]
Hoarseness
  • 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.[symptoma.com]
  • 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]
  • ACUTE LARYNGITIS (SIMPLE)- SYMPTOMS• Hoarseness of voice• Discomfort• Pain• Instant paroxysmal cough• General cold• Dryness of throat• Malaise• fever 5.[slideshare.net]
Hoarseness
  • 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.[symptoma.com]
  • 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]
  • ACUTE LARYNGITIS (SIMPLE)- SYMPTOMS• Hoarseness of voice• Discomfort• Pain• Instant paroxysmal cough• General cold• Dryness of throat• Malaise• fever 5.[slideshare.net]
Stridor
  • 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.[symptoma.com]
  • […] in repose and no retraction;- medium, score 2-7: the stridor is present and in repose, the retraction is moderate, tachypnea, tachycardia, maintains interest for people and the surrounding environment.[essaymonster.net]
  • Stridor is a sign of upper airway obstruction. In children, laryngomalacia is the most common cause of chronic stridor, while croup is the most common cause of acute stridor.[aafp.org]
  • A congenital form results in neonatal stridor or laryngotracheitis, often requiring tracheotomy but resolving with age.[translate.academic.ru]
  • A cough that resembles the barking dog occurs along with stridor breathing, but the voice is clear and resonant. Just before morning, breathing improves and during the day it may be fine.[laryngitisknowledgebase.com]
Pneumonia
  • .-) J81 Pulmonary edema excludes: chemical (acute) pulmonary edema (J68.1) hypostatic pneumonia (J18.2) passive pneumonia (J18.2) pulmonary edema due to external agents (J60-J70) pulmonary edema with heart disease NOS (I50.1) pulmonary edema with heart[codelay.com]
  • The percentage of children with pneumonia in history among children with 1–3 episodes of laryngotracheitis and children with recurent laryngotracheitis was 19.5% and 20.3%, respectively.[med-expert.com.ua]
  • - etiology and treatment Atypical pneumonia Diagnosis and therapy of urinary tract infections Infections in patients with neutropenia, complement deficiency and asplenia Infections in patients with cellular and humoral imunodeficiency Congenital and[wikilectures.eu]
  • Penicillin-resistant Streptococcus pneumoniae in acute otitis media: risk factors, susceptibility patterns, and antimicrobial management. Pediatr Infect Dis J 1995; 14:751-759. ‎ Página 124 - ... combination of the two.[books.google.es]
  • Therefore, other agents, such as Streptococcus pyogenes, Streptococcus pneumoniae, and Staphylococcus aureus, now represent a larger portion of pediatric cases of epiglottitis in vaccinated children.[clinicalgate.com]
Nausea
  • I was experiencing terrible viral throat infection white spots tonsils sore throat jaw sore fever migraine headaches fatigue insomnia and nausea.[elmemesser.eu]
  • ANGIONEUROTIC OEDEMA• May be allergic, non allergic OR hereditary and non hereditary• Recurrent attacks of local swelling in various parts of the body: face, larynx, limbs, buttocks• Death occurs because of the edema of the larynx• Colic, nausea, vomiting[slideshare.net]
Loss of Appetite
  • 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]
  • Loss of appetite and persistent thirst accompany painful deglutition. The pulse is full and the skin hot and dry.[operatingmicroscopes.com]
Choking
  • Typical is frightened expression of a child choking and audible whistling inhale and retracting well below the Adam’s apple. The condition is accompanied by fever, cough štěkavým, elevated temperature.[sicknessfinder.com]
  • A history of aspiration or choking can be obtained in 90 percent of cases.[aafp.org]
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]
  • 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]
  • A considerable degree of face cyanosis can occur. Body Temperature is slightly elevated, and the general condition is not heavily disturbed.[laryngitisknowledgebase.com]
  • If a child with medium obstruction becomes agitated or tired, it is a sign of progression to the severe form;- severe, score 7: stridor and ample retraction, also present in repose, cyanosis, tachycardia, convulsion or obnubilation, loss of interest for[essaymonster.net]
  • Cyanosis is diffuse. Pulse nitividny with fallout on the breath, tachycardia. Child Anxiety gives way to lethargy, drowsiness, confusion arises.[medicalformat.com]
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]
  • 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]
  • A considerable degree of face cyanosis can occur. Body Temperature is slightly elevated, and the general condition is not heavily disturbed.[laryngitisknowledgebase.com]
  • If a child with medium obstruction becomes agitated or tired, it is a sign of progression to the severe form;- severe, score 7: stridor and ample retraction, also present in repose, cyanosis, tachycardia, convulsion or obnubilation, loss of interest for[essaymonster.net]
  • Cyanosis is diffuse. Pulse nitividny with fallout on the breath, tachycardia. Child Anxiety gives way to lethargy, drowsiness, confusion arises.[medicalformat.com]
Tachycardia
  • If a child with medium obstruction becomes agitated or tired, it is a sign of progression to the severe form;- severe, score 7: stridor and ample retraction, also present in repose, cyanosis, tachycardia, convulsion or obnubilation, loss of interest for[essaymonster.net]
  • There tachycardia, agitation, sleep disturbances. Grade III stenosis. There is a strong inspiratory dyspnea with indrawing during breathing jugular fossa, intercostal spaces and the epigastric region.[medicalformat.com]
  • […] stridor View/Print Table TABLE 3 Physical Examination Findings in the Evaluation of Stridor in Children Physical findings Possible etiology General Cyanosis Cardiac disorder, hypoventilation with hypoxia Fever Underlying infection Toxicity Epiglottitis Tachycardia[aafp.org]
  • 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]
  • Use of racemic epinephrine frequently has been proposed and is widely thought to decrease the incidence of tachycardia and hypertension. Evidence to support these beliefs could not be found.[ahcmedia.com]
Thrombosis
  • Infections in Childhood, Ear, Nose and Throat Aspects; effect of weather conditions and pollution on the incidence of acute subglottic laryngitis ... 0 K00.0 Portal vein thrombosis and phlebitis of portal vein Secondary lymphedema Acute sore throat due[acronymattic.com]
Urticaria
  • .-) 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 of later[codelay.com]
  • Unilateral decreased air entry Foreign body in ipsilateral bronchus Associated signs Arrhythmias, significant heart murmurs, abnormal heart sounds Structural heart disease Cutaneous hemangiomas Subglottic hemangioma Peripheral neuropathy Vocal cord paralysis Urticaria[aafp.org]
Flushing
  • The face is flushed, the lips purple, the nails blue, and every muscle tense and contracted all of the characteristic symptoms of marked dyspnea.[operatingmicroscopes.com]
Foreign Body Sensation
  • Symptom Chronic or Intermittent dysphonia, vocal strain, foreign body sensation, excessive throat mucus, Postnasal discharge and cough.[gradestack.com]
Seizure
  • Seizures accompanying false croup, due to reflex spasm of the larynx and can be stopped attempts to call an alternative reflex. To do so, press on the root of the tongue, causing a gag reflex, or tickle in the nose, causing sneezing reflex.[medicalformat.com]
  • That true spasm of the laryngeal muscle is a prominent factor in these seizures is asserted by Rilliet and Benitez,' D'Espine and Picot, J.[operatingmicroscopes.com]

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]
  • It is also acute and self-limiting; thus treatment given is supportive. Respiratory manifestations of the condition include dyspnea, cough, stridor, and hoarseness.[symptoma.com]
  • RESULTS: During a 1 year follow-up period four children showed asthma symptoms and in three of these patients recurrences of croup attacks disappeared after asthma treatment with nebulized budesonide.[ncbi.nlm.nih.gov]
  • […] laryngitis and subglottic edema (Pseudosulcus) Sequelae of Laryngopharyngeal Reflux - Subglottic stenosis - Carcinoma larynx - Contact ulcer/granuloma - Cricoarytenoid joint fixity - Vocal nodule/polyp - Sudden infant deaths - Laryngomalacia (Association) Treatment[gradestack.com]

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]
  • To diagnose false croup has a favorable prognosis and on the background of adequate therapy usually results in complete recovery.[medicalformat.com]
  • 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]

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]
  • 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]
  • 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]
  • 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. ; PMid:10094451 6. Sherman CB, Tosteson TD, Tager IB et al. 1990. Early childhood predictors of asthma. Am J Epidemiol. 132; 1: 83—95. PMid:2356817 7.[med-expert.com.ua]
  • Epidemiology Accurate figures regarding acute laryngitis are not available, as the condition often goes unreported.[patient.info]
Sex distribution
Age distribution

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

  • 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]
  • […] 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]
  • Prevention Prevention of laryngitis is the same as for any upper respiratory infections.[medical-dictionary.thefreedictionary.com]
  • For statistics data there has been used the EPIINFO aplication, 6.0 version, a program of The Center of Disease Control and Prevention - Atlanta, with the Student method (test t) and χ2.RESULTS Of the total number of 88 children which were paraclinically[essaymonster.net]
  • 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]

References

Article

  1. 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.
  2. Cherry JD. Croup. N Engl J Med. 2008;358(4):384–391.
  3. Rosekrans JA. Viral croup: current diagnosis and treatment. Mayo Clin Proc. 1998;73(11):1102–1107.
  4. Wood JM, Athanasiadis T, Allen J. Laryngitis. BMJ. 2014;349:g5827.
  5. Vaughan CW. Current concepts in otolaryngology: diagnosis and treatment of organic voice disorders. N Engl J Med. 1982;307(14):863-866.
  6. Ng ML, Gilbert HR, Lerman JW. Some aerodynamic and acoustic characteristics of acute laryngitis. J Voice. 1997;11(3):356-363.
  7. 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.
  8. Schwartz SR, Cohen SM, Dailey SH, et al. Clinical practice guideline: hoarseness (dysphonia). Otolaryngol Head Neck Surg. 2009;141(3 suppl 2):S1-S31.

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Last updated: 2019-07-11 20:23