Laryngology infectious disorders Flashcards
What viruses have been associated with acute viral
laryngitis?
Rhinovirus, parainfluenza, influenza, adenovirus, respiratory
syncytial virus, herpes simplex virus (HSV), coronavirus
What medication has been shown to significantly
improve discomfort associated with acute viral laryngitis?
Nonsteroidal anti-inflammatory drugs (NSAIDs) In a prospective, double-blinded study, flurbiprofen loz-
enges were shown to significantly improve sore throat associated with acute viral laryngitis compared with
placebo.
Should steroids be given for acute viral laryngitis?
Treatment is primarily supportive (hydration and voice rest) with escalation for evidence of airway compromise (ste-
roids, PPI, antibiotics for secondary infection, humidifica-
tion). However, a single dose of dexamethasone (0.16 mg/kg) has been shown to decrease overall severity of
moderate to severe laryngotracheitis in pediatric patients
during the first 24 hours after injection.
Describe the clinical manifestations of parainfluenza virus infection in adults.
● Immunocompetent: Mild upper respiratory tract infection
●Immunocompromised: Pneumonia (can be fatal)
What infectious agents are potential causes of epiglottitis in adults?
● A broad range of bacterial (H. influenzae type b[Hib]], other Haemophilus strains, Streptococcus pneumonia,
Staphylococcus aureus, β-hemolytic streptococci, etc.),
viral (HSV type 1, varicella zoster virus, parainfluenza
virus type 3, influenza B virus, Epstein-Barr virus), and
fungal (candida) infections
● Noninfectious causes are also possible (thermal, mechanical, or chemical injury).
How does adult supraglottitis (epiglottitis) differ
from pediatric epiglottitis?
Manifestation is often less dramatic, with the most
common initial symptoms and signs including sore throat,
dysphagia, fever, and dyspnea. Airway intervention is
required in less than 20% of cases.
In an adult with epiglottitis demonstrating mild
respiratory distress, < 50% obstruction of the
laryngeal inlet, without stridor, drooling, or cyanosis, what is the management strategy of choice?
Close monitoring in the intensive care unit (ICU) with an
emergency airway cart available is preferred, as well as
empiric antibiotics including a third-generation cephalo-
sporin and an anti-staphylococcal antibiotic with activity
against MRSA (methicillin-resistant Staphylococcus aureus).
Glucocorticoids can be considered but are not routinely
recommended.
Primary infection of the laryngeal cartilage can occur after trauma, radiation, intubation, tracheostomy, or foreign body aspiration. Cancer and relapsing polychondritis are also risk factors. Such an infection is called what?
Chondritis (primarily impacting the cartilage) or perichondritis (impacting the perichondrium + /- underlying cartilage)
What organism is the most common cause of acute fungal laryngitis?
Candida albicans
How do you confirm the diagnosis of candidal
laryngitis?
Tissue biopsy is generally done to rule out carcinoma or
swab and fungal stains (not routinely performed).
What fungal strains are responsible for chronic fungal laryngitis?
Blastomycoces (Southern United States), Histoplasma (Ohio and Mississippi River valleys), Coccidioides (southwestern United States and Mexico), Paracoccidioides, and Cryptococcus spp. Candidal laryngitis is more commonly acute, but it can be chronic as well.
What are risk factors for fungal laryngitis?
Laryngopharyngeal reflux, immunosuppression, systemic or
inhaled steroid use, broad-spectrum antibiotic therapy, and
smoking
How is fungal laryngitis treated?
Systemic antifungals (i.e., amphotericin B, ketoconazole, itraconazole, fluconazole, nystatin). Topical therapy can also be used in the form of troches or lozenges (i.e., miconazole, clotrimazole, nystatin); however, this therapy is not recommended for invasive or systemic infections and often does not lead to long-term control.
What risk factors predispose a person to developing chronic bacterial laryngitis?
Previous prolonged intubation, relapsing polychondritis,
history of recent viral laryngitis, compromised immune
status, reflux
