Laryngotracheal infections BALASUBRAMANIAN THIAGARAJAN drtbalu's otolaryngology online 1

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 2

Etiology  URI  Neck space infections  GERDS  Non specific inflammation (sarcoidosis, Wegner’s granomas)  Allergy  Inhalation of toxic fumes drtbalu's otolaryngology online 3

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 4

Indirect laryngoscopy  Inflammation involving mucosa of supraglottis / glottis / subglottis  Vocal cord reddish & oedematous  Pooling of saliva is there is odynophagia drtbalu's otolaryngology online 5

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 6

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 7

Clinical features  Drooling  Painful swallowing  Voice change  Inflamed epiglottis, aryepiglottic folds, arytenoids and ventricular bands  Cervical adenopathy drtbalu's otolaryngology online 8

Radiology  Enlarged epiglottis “Thumb sign”  Absence of deep well defined vallecula “Vallecular sign”. drtbalu's otolaryngology online 9

Complications  Respiratory distress  Epiglottic abscess  Internal jugular vein thrombosis drtbalu's otolaryngology online 10

Management  If a child should be admitted  Airway compromise – Tracheostomy  Antibiotics – III generation cephalosporins drtbalu's otolaryngology online 11

Croup  Laryngotracheal bronchitis  “Sore throat with hoarse breathing”  Children 6 months – 3 yrs  Uncommon in adults  Subglottic oedema  Biphasic stridor drtbalu's otolaryngology online 12

Etiology  Commonly viral  Paramyxovirus, parainfluenza virus Types I and II have been implicated  In adults herpes simplex have been implicated drtbalu's otolaryngology online 13

Clinical features  Cough  Sore throat  Malaise  Mild fever  Inspiratory stridor drtbalu's otolaryngology online 14

X-ray chest  Narrowing seen at the level of subglottis  Steeple sign / pencil sign drtbalu's otolaryngology online 15

Management  Self limiting disease  Patient improves within a day  Completely recovers in 3-4 days  Oxygenation  Steroids  Adrenaline nebulisation drtbalu's otolaryngology online 16

Score Inspiratory stridor -Audible with steth Audible without steth Retraction-MildModerateSevere Air entryNormalDecrease d Severely decreased CyanosisNoneWith agitation At rest Conscious level altered Westley score Maximum – mild croup 4-7 moderate croup Above 8 severe croup drtbalu's otolaryngology online 17

drtbalu's otolaryngology online 18