Infections Of Larynx Flashcards
Functions of larynx
Protection of airways
Swallowing
Respiration
Phonation
What is stridor?
High pitched noise that is produced as a result of turbulence of air when it passes down through narrowed airways
Stridor is produced when there’s obstruction in the larynx upto secondary bronchi
What are the types of stridor ?
Inspiratory
Expiratory
Biphasic
Types of stridor
Inspiratory
Expiratory
Biphasic
What causes Inspiratory stridor ?
Supraglottic and glottic conditions
What causes expiratory stridor?
Obstruction of intrathoracic trachea upto secondary bronchi
This is because during inspiration there will be decreased intrathoracic pressure that causes the airway to expand well allowing air to flow in . But during expiration the pressure in the intrathoracic cavity builds up and causes narrowing of airways causing expiratory stridor
What causes biphasic stridor ?
Subglottis conditions
Here there is cricoid cartilage that is a complete ring and obstruction at this level while not be altered by the external pressure and stridor is present both during inspiration and expiration
Also seen in cervical trachea and in some glottic conditions
What is stretor?
Low pitched noise that is produced as a result of obstruction above the level of larynx ( nose , nasopharynx ,oropharynx )
What is wheeze ?
Noise that is produced as a result of obstruction beyond secondary bronchi
If stridor changes with positions then where is the pathology?
At the level of supraglottis ( at the level of inlet )
Stridor increase in supine position and decrease in prone position/bending forward
Speech in glottic conditions
Will be changed
It will be hoarseness , Dysphonia , aphonia
Speech will be mostly normal in supraglottic conditions but can be sometimes muffled
Dysphagia is seen when which part is affected ?
Dysphagia / odynophagia / drooling occurs when there’s inflammation of epiglottis , arytenoids(inlet is affected)
Drooling of saliva is seen in infants (mostly) as it is very painful even to swallow the saliva
Acute Epiglottitis is also known as
Acute supraglottic laryngitis
What is acute Epiglottitis / supraglottic laryngitis ?
Acute inflammatory condition confined to supraglottic structures ,I.e,epiglottis , Aryepiglottic folds , arytenoids
Causative organism of supraglottic laryngitis / acute Epiglottitis
Earlier - H.Influenza type B
Now-a-days - Streptococcus
Age group affected in acute Epiglottitis / supra glottic laryngitis
2-7 years - most common
Adults sometimes can also be affected
Clinical features of supra-glottic laryngitis / acute Epiglottitis
Sore throat
Dysphagia / odynophagia / drooling of saliva - in adults
Dyspnoea and stridor (Inspiratory) - due to edema of the involved structures that will obstruct the airways - in children
Fever - due to septicaemia
Voice may be normal / muffled
Stridor will be more in supine position and less in prone / bending forward position /tripod position
Overall the child will have a toxic / sick appearance
Investigations for acute Epiglottitis / supra glottic laryngitis
Indirect laryngoscope is contraindicated as it will precipitate laryngospasm and causes complete obstruction
Preffered investigation - x ray of lateral soft tissue neck
X ray findings in acute Epiglottitis / supra epiglottis laryngitis
Thumb sign - swollen epiglottis
When is endoscopy / IDL is done ?
For children it is done in ot under intubation
For adults it can done in op as there’s is not much edema when compared to children - edema is not so much as submucous tissue is so tight in adults
Management of acute Epiglottitis / acute supraglottic laryngitis
Hospitalisation - as there is risk / danger of airway obstruction
Secure the airway - either by intubation / tracheostomy (if intubation is not possible)
I.V antibiotic - to reduce infection = ampicillin / third generation cephalosporins are used
Steroids - to reduce edema = hydrocortisone / dexamethasone
Adrenaline nebulisation - to improve breathing as it Causes vasoconstriction and bronchodilation
Hydration - since they will be dehydrated
What is the other name for croup ?
Acute laryngo - tracheo - bronchitis
Croup is caused by
It is an viral infection (parainfluenza types 1 and 2 )
Secondary infection by gram positive cocci
Affects child between 6 months - 3 years of age
Symptoms of croup
Starts as URTI with hoarseness of voice and croupy / barking / seal like cough
Fever
Initially the stridor is Inspiratory later it becomes biphasic ; doesn’t change with position
Difficulty in respiration will gradually increase
There will be no Dysphagia , odynophagia , drooling of saliva
X ray sign of croup
Steeple sign / pencil tip sign.
Difference between croup and acute Epiglottitis
In croup - the patient will have running nose , malaise , general symptoms ; will have a gradual onset
In acute Epiglottitis - the onset will be acute and will be localised
Management of croup
Hospitalisation - due to respiratory obstruction / breathing difficulty
Do laryngoscope after anaesthesia and take swab for to identify if there’s any secondary infection and intubate
Antibiotics if there’s secondary infection - ampicillin
Steroids - to relieve edema
Adrenaline nebulisation - to improve breathing as it causes vasoconstriction and dilation of bronchi
Hydration
Humidification - to soften crusts and tenacious secretions in tracheobronchial tree
Heliox - helium : oxygen (70:30) = make the air flow to become more laminar
Tb larynx findings
Pseudoedema of epiglottis - turban epiglottis
Mouse nibbled vocal cords
Mamillated arytenoids
Here , TB IS PAINFUL
