Laryngitis - Croup and Epiglottitis

February 2017
Laryngitis is characterized by an inflammation of the larynx, the organ found at the junction between the pharynx and trachea. This is the main organ of phonation, i.e. the ability to speak. The larynx contains two vocal cords as well as muscles and cartilage, all involved in the creation of sound. Laryngitis can be acute, punctual, or chronic. Acute laryngitis is infectious, overwhelmingly caused by a virus. It usually affects children, and is more common in adult men than women. Acute laryngitis is infectious, overwhelmingly caused by a virus. A recent nearby infection is frequently at the root of this infection. Tobacco, cold air breathing and vocal abuse also promote laryngitis.


Definition

Laryngitis is an acute inflammation of the larynx caused by a bacterial or viral infection, or an allergy. During laryngitis the larynx also known as the voice box becomes inflamed and swollen, preventing the passage of air.

In children under 2 years laryngitis is otherwise known as Croup which affects the larynx, trachea (wind pipe) and bronchi (lungs).

In children between the ages of 1 and 6 years, severe laryngitis can cause sufficient swelling to cause airway obstruction and asphyxiation. This is called epiglottitis.

Symptoms



After an abrupt onset, acute laryngitis will cause the following symptoms:
  • hoarseness in the voice;
  • difficulty speaking;
  • cough, classically described to sound like "barking";
  • tightness in the throat;
  • breathing difficulties sometimes in children because of the inflammation;
  • difficulty eating and swallowing.


Symptoms usually occur in children under 2 years. It has a slow onset and is usually a mild infection.
  • Harsh barking 'croupy' cough, which is often worse at night time.
  • Stridor - noisy breathing on inspiration
  • Hoarse voice
  • Mild fever
  • Shortness of breath.
  • Sore throat, pain on swallowing and swollen neck glands.
  • Can follow a cold
  • Tiredness, general aches and pains
  • It is more frequent in boys than girls
  • It usually caused by a virus
  • It is more prevalent in winter.

Diagnosis

The diagnosis is frequently made, especially in children, by observing a characteristic cough or abnormal voice, and is done so without the need for any further examination. Sometimes it may be helpful to observe the larynx via a technical indirect laryngoscopy, with the help of a light reflected on a mirror placed into the mouth.

Treatment

Treatment is symptomatic and can be done at home:
  • resting the voice;
  • limiting exposure to predisposing factors: tobacco, dust ...;
  • anti-inflammatory drugs or corticosteroids are often given, sometimes as an emergency if the child has difficulty breathing.

In children, hospitalization for monitoring is possible in case of breathing difficulties despite corticosteroid use.

Antibiotics are only administered if any secondary infection is suspected; otherwise they are of limited use. Sometimes oral steroids are given to reduce the inflammation and swelling. Humidified air can help - place your child in a steamy bathroom.

Keep your child calm and avoid them from becoming stressed as crying can make symptoms worse. Treat any fever - give paracetamol or ibuprofen. Keep your child upright - this will help with their breathing. Cough medicines do not work and often cause drowsiness therefore avoid them.

Acute Epiglottitis

Occurs in children most commonly between 1 and 6 years and has rapid onset. Acute epiglottitis is a localised infection of the supraglottic larynx. It is usually caused by the infection - Haemphilus influenzae, and children should be admitted to hospital in case of airway obstruction.

Symptoms

Epiglottitis has a rapid onset, it can be life threatening and urgent medical attention is necessary.
  • Breathing is increasingly difficult and noisy
  • If in a newborn they tend not cry
  • High fever
  • Muffled voice
  • Drooling saliva
  • The thorax grows hollow during each inspiration
  • Sweaty, clammy and very pale - grey in colour.
  • The lips are cyanosed (bluish)

Urgent medical help

Epiglottitis requires urgent medical help - what to do whilst seeking help. Telephone 999 for ambulance or go directly to hospital
  • Remain calm and relaxed: a distressed child will deteriorated quickly.
  • Speak gently
  • Keep your child upright - do not make him lie down
  • Humidify the atmosphere:
    • Steam humidifies the atmosphere and decreases the oedema of the respiratory tract.
    • Make the child breathe in a hot and wet air by producing vapour for at least 15 minutes.
    • This can be achieved in the kitchen or bathroom, boiling some water, keeping the windows and doors closed or turning on the shower at the highest temperature. Mist on the mirror is a good sign of humidity

Treat the fever

Allow cool light clothing only - no blankets or duvets. Apply a wet towel on his forehead. Check that the temperature of the room is not too high and does not exceed 19 or 20 degrees.

Keep them hydrated: offer him sips of water every ten minutes roughly. Given paracetamol or ibuprofen to reduce the fever, but avoid distressing the child.

Do not give any other medicine without medical advice: it may do more harm than good. Seek medical advice if any fever persists of other symptoms present such as : diarrhoea, stomach pains and vomiting.

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