Croup, Epiglotitis, Laryngitis, & Hoarsness

Question 1

What typically causes Viral Croup?

Answer 1

• Parainfluenza (most common cause)

- other viruses; RSV, influenza, rubeola virus, adenovirus, mycoplasma pneumonia

Question 2

How does the parainfluenza virus in viral croup effect kids Vs. Adults?

Answer 2

Kids=> causes inspiratory stridor, worst at night.

Adults=> laryngitis

Question 3

What are the signs and Symptoms of Viral Croup?

Answer 3

• afebrile or low grade fever
• inspiratory stridor
• barking cough**
• gets worse at night

Question 4

What is the defining characteristic in a radiographic image of viral coup?

Answer 4

AP neck XR = has a “steeple sign”***

Question 5

What is the treatment for viral coup?

Answer 5

• cool moist air helps
• oxygen
• racemic epinephrine via nebulizer
• Dexamethasone (glucocorticoid)

Question 6

What are the signs and symptoms of Epiglottis?

Answer 6

• High Fever
• toxic appearance
• drooling
• dysphagia
• muffled voice
• “tripod”position
• soft stridor–> inspiratory retractions
• “Thumbprint”

** can very suddenly lead to complete airway obstruction

Question 7

What would a lateral neck x-ray look like for epiglottis?

Answer 7

“Thumbprint” sign

Question 8

What is the etiology of Epiglottitis?

Answer 8

1. Hemophilus influenza; Type B

Question 9

What is the Tx of Epiglottitis?

Answer 9

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

Question 10

What is a complication of epiglottitis?

Answer 10

• MC in adults now than kids b/c vaccine

Question 11

What are some Ddx of Hoarseness?

Answer 11

• laryngitis
• Laryngopharyngeal reflux
• squamous cell carinoma
• laryngeal papillomatosis
• prebyphonia (getting old)
• vocal cord nodule, polyp, cyst, paralysis

Question 12

Laryngitis is…?

Answer 12

inflammatory process involving the larynx; infections & noninfections

Question 13

What are the causes of infectious Laryngitis? (most often times acute)

Answer 13

1. Viral (rhinovirus, influenza virus, parainfluenza virus, adenovirus,coxsackie, RSV

2, Barcterial- Branhamella Catarrhalis, H influenza, Group A Stre, C Diptheriae

Question 14

What are the causes of noninfectious Laryngitis?

Answer 14

• cancer
• overuse
• reflux

Question 15

Presentation of Laryngitis?

Answer 15

• hoarness
• reduced vocal pitch/aphonia
• Viral Respiratory infections w rhinorrhea, casal congestion cough etc

Question 16

What does Acute Viral laryngitis look like through a laryngoscopy?

How about chronic?

Answer 16

1. Acute-> diffuse laryngeal erythema/edema
   - -> Vascular engorgement of vocal tubes
   - ->irregular vocal fold edges.
2. Chronic–> often= mucosal nodules & ulcerations visible (similar to laryngeal cancer)

Question 17

TX/ RX of Laryngitis

Answer 17

• 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!)

Question 18

What RX does data not support in the TX of laryngitis?

Answer 18

Antihistamines & Corticosteroids.

Abx- also not helpful in health patients.

Question 19

Larynogopharyngeal Reflux ( sings/symptoms)

Answer 19

• frequent throat clearing
• dry cough
• hoarseness
• globus sensation
• no heartburn in >60% patients
• edema inferior to true vocal fold edge– w thick mucos

Question 20

What is Leukoplakia?

Answer 20

White coating, benign (keratosis)

Can be precancerous/malignancy

Question 21

What specific strains are implicated in the cause of Laryngeal Papillomatosis? (3)

Answer 21

HPV 6,11, & 16

Question 22

How can you prevent Laryngeal Papillomatosis?

Answer 22

HPV vaccine.

Question 23

What is the TX for Laryngeal Papillomatosis?

Answer 23

• spontaneous remissions do occur.
• HPV (quadrivalent) vaccine–> used as a prophylactic
• prevent airway obstruction
• direct surgical resection
• tracheostomy (occasionally)

Question 24

What is Glottic Stenosis?

Answer 24

Narrowing of larynx at the glottis level (posterior most common) from webbing, fibrosis, or scarring.

Question 25

What is Laryngomalacia?

Answer 25

Benign congenital disorder, where the cartilaginous support of supraglottic structures= underdeveloped.
Epiglottis- curls in on itself (omega shaped)

Question 26

Tx for Laryngomalacia?

Answer 26

surigical epiglottoplasty if there is severe airway obstruction.