Laryngitis and Epiglottitis

Question 1

What is stridor?

Answer 1

Stridor is a high-pitched, wheezing sound caused by disrupted airflow. Stridor may also be called musical breathing or extrathoracic airway obstruction. Airflow is usually disrupted by a blockage in the larynx (voice box) or trachea (windpipe).

• inspiratory → laryngeal obstruction
• expiratory → bronchial obstruction
• biphasic → subglottic

Question 2

What are causes of stridor in children?

Answer 2

• nose + pharynx → choanal atresia, thyroglossal cyst, macroglossia, hypertrophic tonsils/adenoids, retropharyngeal/peritonsillar abscess
• larynx → laryngomalacia, laryngeal web, croup, epiglottitis, vocal cord paralysis, laryngotracheal stenosis, intubation, foreign body, cystic hygroma, laryngospasm, anaphylaxis
• trachea → tracheomalacia, tracheitis, external compression

Question 3

What are the causes of stridor in adults?

Answer 3

• trauma
• anaphylaxis
• acute laryngitis
• foreign body
• laryngospasm
• malignancy

Question 4

Diptheria is an illness caused by toxigenic strains of Coryneobacterium diptheriae. It is an endemic in many parts of the world and still occurs sporadically in the US.

What are the clinical features?

Answer 4

• typical age group <15 or >25
• exposure to infected individual + travel to endemic regions
• unvaccinated / inadequately vaccinated
• sore throat
• dysphagia or dysphonia
• dyspnoea and/or resp compromise
• croupy cough
• pseudomembrane formation → brown-greyish membrane covering the tonsils, pharynx, and larynx
• swelling of the neck (lymphadenopathy), malaise, stridor
• skin lesions
• low-grade fever

Diptheria is a NOTIFIABLE DISESE, diagnose w/ throat swab + culture, Rx → diptheria antitoxin + erythromycin + isolation

Question 5

If you suspect epiglottitis, what should you not do?

Answer 5

• no action should be taken that could stimulate a child w/ suspected epiglottitis
• do not examine throat, lie pt down, separate from parent or take blood as this may evoke complete airway obstruction
• it’s a clinical diagnosis
• lab or other interventions should not preclude or delay timely control of the airway in a suspected case of epiglottitis

Question 6

What are the relevant investigations for epiglottitis?

Answer 6

• laryngoscopy → key to confirming diagnosis, but also therepeautic as an airway can be established in same setting if a direct laryngoscopy comences, this should be performed in the OR as an emergency surgical airway can be obtained if endotracheal intubation is not possible
• lateral neck radiograph → only to be obtained w/ HCP capable of securing airway with proper equipment available during the test

Question 7

What is the management of epiglottitis?

Answer 7

• secure airway + supplemental oxygen
  
  • if intubation not possible during laryngoscopy then tracheostomy
• intravenous antibiotics → co-amoxiclav or ceftriaxone
• adjuncts → corticosteroids, racemic epinephrine, prolonged intubation

The tracheal tube can normally be removed after 24hrs and the child has normally totally recovered in 2-3 days, Abx treatment continues for 3-5 days

Question 8

What is the clinical presentation of epiglottitis?

Answer 8

• sore throat
• dysphagia
• drooling
• toxic appearance
• acute distress
• fever
• tripod position
• difficulty breathing
• muffled voice, stridor, irritability

Question 9

What vaccination is used to reduce the occurrence of epiglottitis?

Answer 9

Haemphilus Influenzae type B (HiB)

Question 10

Acute laryngitis is inflammation of the larynx, which can lead to oedema of the true vocal folds.

What are the causes?

Answer 10

INFECTIOUS:

• Viral (most common) → rhinovirus, parainfluenza, RSV
• Bacterial → moraxella, haemophilus, streptococcus, staph
• Fungal → candida, blastomyces, histoplasma

NON-INFECTIOUS:

• Irritant laryngitis → toxic fumes, active or passive smoking
• Allergic
• Traumatic → esp vocal abuse
• Reflux
• Autoimmune

Question 11

Acute laryngitis usually lasts <7 days. Subacute is when the clinical presentation lies between 7 days - 3 weeks.

What are the clinical features?

Answer 11

• hoarseness + periods of aphonia
• dysphagia + odynophagia
• sore throat
• cough
• hyperaemia of oropharynx
• gastro-oeseophageal reflux
• fatigue, malaise, fever
• enlarged tonsils + lymph nodes

Question 12

What are the investigations for laryngitis?

Answer 12

• laryngoscopy → oedema + erythema of true vocal folds; thick, copious, white-yellow secretions in glottis

Can also do biopsy (TB), cultures, CXR etc. if suspecting specific infections

Question 13

What is the treatment for viral laryngitis?

Answer 13

• analgesia → paracetamol 1g QDS
• vocal hygeine → voice rest (3-7days), inc hydration + steam inhalation
• avoid smoking
• treat underlying infection
• voice therapy?

Question 14

Chronic laryngitis is defined as laryngitis persisting beyond 3 weeks. Hoarseness is a serious sign and if it persists the larynx needs to be inspected by an ENT surgeon w/ a view to biopsy.

What are some predisposing factors to chronic laryngitis?

Answer 14

• smoking, alcohol use
• habitual shouting or faulty voice production
• teachers, singers, actors are at particular risk
• in severe cases → dysplasia w/ disorganised mucosal cell architecture may occur → carcinoma
• pt’s present w/ hoarse voice that tires easily + they clear throat often