This presentation discusses acute laryngotracheal infections and their management

1. Laryngotracheal
infections
BALASUBRAMANIAN THIAGARAJAN
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2. Acute 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
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3. Etiology
 URI
 Neck space infections
 GERDS
 Non specific inflammation (sarcoidosis, Wegner’s granomas)
 Allergy
 Inhalation of toxic fumes
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4. Clinical features
 Change / loss of voice
 Sore throat
 Otalgia
 Difficulty in swallowing / painful swallow
 Tender larynx
 Cervical adenopathy
 Difficulty in breathing
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5. Indirect laryngoscopy
 Inflammation involving mucosa of
supraglottis / glottis / subglottis
 Vocal cord reddish & oedematous
 Pooling of saliva is there is
odynophagia
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6. Management
 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
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7. Acute 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
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8. Clinical features
 Drooling
 Painful swallowing
 Voice change
 Inflamed epiglottis, aryepiglottic folds, arytenoids and ventricular bands
 Cervical adenopathy
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9. Radiology
 Enlarged epiglottis “Thumb sign”
 Absence of deep well defined
vallecula “Vallecular sign”.
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10. Complications
 Respiratory distress
 Epiglottic abscess
 Internal jugular vein thrombosis
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11. Management
 If a child should be admitted
 Airway compromise – Tracheostomy
 Antibiotics – III generation cephalosporins
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12. Croup
 Laryngotracheal bronchitis
 “Sore throat with hoarse breathing”
 Children 6 months – 3 yrs
 Uncommon in adults
 Subglottic oedema
 Biphasic stridor
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13. Etiology
 Commonly viral
 Paramyxovirus, parainfluenza virus Types I and II have been implicated
 In adults herpes simplex have been implicated
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14. Clinical features
 Cough
 Sore throat
 Malaise
 Mild fever
 Inspiratory stridor
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15. X-ray chest
 Narrowing seen at the level of
subglottis
 Steeple sign / pencil sign
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16. Management
 Self limiting disease
 Patient improves within a day
 Completely recovers in 3-4 days
 Oxygenation
 Steroids
 Adrenaline nebulisation
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17. Score 0 1 2 3 4 5
Inspiratory
stridor
- Audible
with steth
Audible
without
steth
Retraction - Mild Moderate Severe
Air entry Normal Decrease
d
Severely
decreased
Cyanosis None With
agitation
At rest
Conscious
level
altered
Westley score
Maximum – 17
2-3 mild croup
4-7 moderate croup
Above 8 severe
croup
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18. drtbalu's otolaryngology online
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