acute laryngotracheal infections

drtb

alu

's oto

lary

ng

olo

gy o

nlin

e

1

Laryngotracheal infectionsBALASUBRAMANIAN THIAGARAJAN

drtbalu's otolaryngology online

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

drtbalu's otolaryngology online

3

Etiology

URI

Neck space infections

GERDS

Non specific inflammation (sarcoidosis, Wegner’s granomas)

Allergy

Inhalation of toxic fumes

drtbalu's otolaryngology online

4

Clinical features

Change / loss of voice

Sore throat

Otalgia

Difficulty in swallowing / painful swallow

Tender larynx

Cervical adenopathy

Difficulty in breathing

drtbalu's otolaryngology online

5

Indirect laryngoscopy

Inflammation involving mucosa of supraglottis / glottis / subglottis

Vocal cord reddish & oedematous

Pooling of saliva is there is odynophagia

drtbalu's otolaryngology online

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

drtbalu's otolaryngology online

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

drtbalu's otolaryngology online

8

Clinical features

Drooling

Painful swallowing

Voice change

Inflamed epiglottis, aryepiglottic folds, arytenoids and ventricular bands

Cervical adenopathy

drtbalu's otolaryngology online

9

Radiology

Enlarged epiglottis “Thumb sign”

Absence of deep well defined vallecula “Vallecular sign”.

drtbalu's otolaryngology online

10

Complications

Respiratory distress

Epiglottic abscess

Internal jugular vein thrombosis

drtbalu's otolaryngology online

11

Management

If a child should be admitted

Airway compromise – Tracheostomy

Antibiotics – III generation cephalosporins

drtbalu's otolaryngology online

12

Croup

Laryngotracheal bronchitis

“Sore throat with hoarse breathing”

Children 6 months – 3 yrs

Uncommon in adults

Subglottic oedema

Biphasic stridor

drtbalu's otolaryngology online

13

Etiology

Commonly viral

Paramyxovirus, parainfluenza virus Types I and II have been implicated

In adults herpes simplex have been implicated

drtbalu's otolaryngology online

14

Clinical features

Cough

Sore throat

Malaise

Mild fever

Inspiratory stridor

drtbalu's otolaryngology online

15

X-ray chest

Narrowing seen at the level of subglottis

Steeple sign / pencil sign

drtbalu's otolaryngology online

16

Management

Self limiting disease

Patient improves within a day

Completely recovers in 3-4 days

Oxygenation

Steroids

Adrenaline nebulisation

drtbalu's otolaryngology online

17

Score 0 1 2 3 4 5

Inspiratory stridor

- Audible with steth

Audible without steth

Retraction - Mild Moderate Severe

Air entry Normal Decreased

Severely decreased

Cyanosis None With agitation

At rest

Conscious level

altered

Westley score

Maximum – 172-3 mild croup

4-7 moderate croupAbove 8 severe croup

drtbalu's otolaryngology online

18

Thank you