Laryngotracheal infections BALASUBRAMANIAN THIAGARAJAN drtbalu's otolaryngology online 1.

drtbalu's otolaryngology online

1

Laryngotracheal infectionsBALASUBRAMANIAN THIAGARAJAN


2Acute 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


3Etiology

URI Neck space infections GERDS Non specific inflammation (sarcoidosis, Wegner’s granomas) Allergy Inhalation of toxic fumes


4Clinical features

Change / loss of voice Sore throat Otalgia Difficulty in swallowing / painful swallow Tender larynx Cervical adenopathy Difficulty in breathing


5Indirect laryngoscopy

Inflammation involving mucosa of supraglottis / glottis / subglottis

Vocal cord reddish & oedematous Pooling of saliva is there is

odynophagia


6Management

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


7Acute 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


8Clinical features

Drooling Painful swallowing Voice change Inflamed epiglottis, aryepiglottic folds, arytenoids and ventricular bands Cervical adenopathy


9Radiology

Enlarged epiglottis “Thumb sign” Absence of deep well defined

vallecula “Vallecular sign”.


10Complications

Respiratory distress Epiglottic abscess Internal jugular vein thrombosis


11Management

If a child should be admitted Airway compromise – Tracheostomy Antibiotics – III generation cephalosporins


12Croup

Laryngotracheal bronchitis “Sore throat with hoarse breathing” Children 6 months – 3 yrs Uncommon in adults Subglottic oedema Biphasic stridor


13Etiology

Commonly viral Paramyxovirus, parainfluenza virus Types I and II have been implicated In adults herpes simplex have been implicated


14Clinical features

Cough Sore throat Malaise Mild fever Inspiratory stridor


15X-ray chest

Narrowing seen at the level of subglottis

Steeple sign / pencil sign


16Management

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 5Inspiratory stridor

- Audible with steth

Audible without steth

Retraction - Mild Moderate SevereAir entry Normal Decrease

dSeverely 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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Laryngotracheal infections BALASUBRAMANIAN THIAGARAJAN drtbalu's otolaryngology online 1.

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