Croup, Epiglotitis, Laryngitis, & Hoarsness Flashcards
What typically causes Viral Croup?
- Parainfluenza (most common cause)
- other viruses; RSV, influenza, rubeola virus, adenovirus, mycoplasma pneumonia
How does the parainfluenza virus in viral croup effect kids Vs. Adults?
Kids=> causes inspiratory stridor, worst at night.
Adults=> laryngitis
What are the signs and Symptoms of Viral Croup?
- afebrile or low grade fever
- inspiratory stridor
- barking cough**
- gets worse at night
What is the defining characteristic in a radiographic image of viral coup?
AP neck XR = has a “steeple sign”***
What is the treatment for viral coup?
- cool moist air helps
- oxygen
- racemic epinephrine via nebulizer
- Dexamethasone (glucocorticoid)
What are the signs and symptoms of Epiglottis?
- High Fever
- toxic appearance
- drooling
- dysphagia
- muffled voice
- “tripod”position
- soft stridor–> inspiratory retractions
- “Thumbprint”
** can very suddenly lead to complete airway obstruction
What would a lateral neck x-ray look like for epiglottis?
“Thumbprint” sign
What is the etiology of Epiglottitis?
- Hemophilus influenza; Type B
What is the Tx of Epiglottitis?
DO NOT WAIT TO TX– can be very dangerous!!
- Immediate endotracheal intubation
- may need tracheostomy
after airway=> stable
- blood-work
- IVs abx (ceftriaxone) –> can be switched to oral abx
What is a complication of epiglottitis?
- MC in adults now than kids b/c vaccine
What are some Ddx of Hoarseness?
- laryngitis
- Laryngopharyngeal reflux
- squamous cell carinoma
- laryngeal papillomatosis
- prebyphonia (getting old)
- vocal cord nodule, polyp, cyst, paralysis
Laryngitis is…?
inflammatory process involving the larynx; infections & noninfections
What are the causes of infectious Laryngitis? (most often times acute)
- Viral (rhinovirus, influenza virus, parainfluenza virus, adenovirus,coxsackie, RSV
2, Barcterial- Branhamella Catarrhalis, H influenza, Group A Stre, C Diptheriae
What are the causes of noninfectious Laryngitis?
- cancer
- overuse
- reflux
Presentation of Laryngitis?
- hoarness
- reduced vocal pitch/aphonia
- Viral Respiratory infections w rhinorrhea, casal congestion cough etc
What does Acute Viral laryngitis look like through a laryngoscopy?
How about chronic?
- Acute-> diffuse laryngeal erythema/edema
- -> Vascular engorgement of vocal tubes
- ->irregular vocal fold edges. - Chronic–> often= mucosal nodules & ulcerations visible (similar to laryngeal cancer)
TX/ RX of Laryngitis
- Time
- avoid use of vocal cords (do not whisper= hyper-functioning of larynx)
- avoid throat clearing
- inhale humidified air
- Hydration
** Tobacco delays resolution (surprise surprise!)
What RX does data not support in the TX of laryngitis?
Antihistamines & Corticosteroids.
Abx- also not helpful in health patients.
Larynogopharyngeal Reflux ( sings/symptoms)
- frequent throat clearing
- dry cough
- hoarseness
- globus sensation
- no heartburn in >60% patients
- edema inferior to true vocal fold edge– w thick mucos
What is Leukoplakia?
White coating, benign (keratosis)
Can be precancerous/malignancy
What specific strains are implicated in the cause of Laryngeal Papillomatosis? (3)
HPV 6,11, & 16
How can you prevent Laryngeal Papillomatosis?
HPV vaccine.
What is the TX for Laryngeal Papillomatosis?
- spontaneous remissions do occur.
- HPV (quadrivalent) vaccine–> used as a prophylactic
- prevent airway obstruction
- direct surgical resection
- tracheostomy (occasionally)
What is Glottic Stenosis?
Narrowing of larynx at the glottis level (posterior most common) from webbing, fibrosis, or scarring.
What is Laryngomalacia?
Benign congenital disorder, where the cartilaginous support of supraglottic structures= underdeveloped.
Epiglottis- curls in on itself (omega shaped)
Tx for Laryngomalacia?
surigical epiglottoplasty if there is severe airway obstruction.
