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]

• Soft Tissue Swelling

  The air pocket that runs parallel to the vallecula may be distorted (the vallecula sign). 105 Prevertebral soft-tissue swelling and ballooning of the hypopharynx may be present. [ahcmedia.com]

• Fishing

  Retropharyngeal and epidural abscess from a swallowed fish bone. Am J Emerg Med 1997;15:381-383. 36. Nadal DM, Lyons KM. "Shotgunning" crack cocaine as a potential cause of retropharyngeal abscess. Ear Nose Throat J 1998;77:47-49. 37. [ahcmedia.com]

• 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]

  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]

• Dyspnea at Rest

  II degree of stenosis characterized by the presence of dyspnea at rest. On the inhale observed retraction jugular fossa and the intercostal spaces. Auscultation auscultated dry wheezing. [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]

• Foreign Body Sensation

  Symptom Chronic or Intermittent dysphonia, vocal strain, foreign body sensation, excessive throat mucus, Postnasal discharge and cough. [gradestack.com]

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].

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.