© Borgis - New Medicine 3/2006, s. 50-52
Mieczysław Chmielik, Anna Kaczmarczyk
Laryngitis in children
Department of Paediatric Otorhinolaryngology, Medical University, Warsaw, Poland
Head of Department: Prof. Mieczysław Chmielik, MD, PhD
Laryngitis in children is a very important diagnostic and therapeutic problem in practice. Several types of laryngitis can be distinguished, which have different aetiology and symptoms, and proper treatment should be ordered. In spite of modern present therapeutic methods laryngitis in children is still a life-threatening condition.
Laryngitis is a group of disorders in which the inflammatory process covers the mucous membrane of all or particular levels of the larynx. These disorders have a different course in children under 4 years old than in children above 4 years old. According to numerous reports laryngitis in small children is more frequently, but not only, a viral infection. Lone articles discuss the role of the allergic factor in the etiopathogenesis of laryngitis.
The most frequent etiopathogenetic factor of laryngitis in small children is the parainfluenza virus . American books describe the influenza virus, rubella virus and varicella-zoster virus as casual factors of laryngitis . Epiglottitis should be described separately. It is caused almost always by Haemophilus influenzae.
The differences mentioned above in the course of laryngitis in children under 4 years old and in children above 4 years old arise from specific variations of the structure of the larynx in these two groups of children. The larynx of a small child is located higher, and the mucous is thicker and contains a large amount of soft tissue. This soft tissue is mainly located under the mucous of the aryepiglottic folds, and especially in the subglottic region. The specific reactivity of the mucous membrane in small children makes them prone to infections, especially viral. Some of these infections may cause oedema of the mucus. The respiratory tract in children is relatively narrow in this region and the chondrous ring limits the size of the subglottic region. So, oedema in this region may have a dramatic course, leading even to acute respiratory distress .
Laryngitis does not always lead to such dramatic situations. So, according to the literature and many years of our own experience the disorder was divided into various types .
1. Diffuse laryngitis – laryngitis diffusa.
2. Acute subglottic laryngitis – laryngitis subglottica acuta.
3. Laryngotracheobronchitis – LTB.
4. Laryngotracheobronchitis malignant – LTB maligna.
5. Acute epiglottitis – Epiglottitis acuta.
Diffuse laryngitis is inflammation of the mucous of the vestibule of the larynx, subglottic region and eventually adjacent parts of the respiratory tract with a low tendency to oedema. This type of laryngitis occurs most often in patients above 4 years old, in young children occurs rarely. The virus is an etiopathogenic factor. The viral infection at the same time or heterochronously usually involves the nose or pharynx. Symptoms include hoarseness even to aphonia, and a scraping or burning sensations in the pharynx. In the case when the infection involves other levels of the respiratory tract, additional symptoms, characteristic for these levels, occur: serous discharge from the nose, dry cough, fever. This type of laryngitis usually does not lead to dyspone, but may lead to subglottic form and then dyspnoea is the dominant symptom.
The treatment of diffuse laryngitis is analogous to the treatment of other viral infections of the respiratory tract and includes: anti-inflammatory drugs, inhalations with pine or eucalyptus oil, and vitamins. Antibiotics should be avoided, except in situations when symptoms of bacterial infection develop. Glycocortycosteroids should be avoided too. They are indicated for others types of laryngitis with dyspnoea.
ACUTE SUBGLOTTIC LARYNGITIS
Acute subglottic laryngitis it is a type of laryngitis in which cushion-like, symmetrical oedema develops in the subglottic region. Erythema of the mucosa of this part and exudations sometimes may be seen. In patients under 4 years old this type of laryngitis is caused more frequently by parainfluenza virus, rarely by adenovirus, ECHO virus and influenza virus. The symptoms of this type of laryngitis include: dyspnoea, inspiratory stridor, hoarseness and a characteristic barking cough. In the case of laryngeal dyspnoea the stridor is inspiratory and differs from dyspnoea of obturation at other levels. Laryngeal dyspnoea is generally inspiratory. In younger children hoarseness is not rare. On examination symptoms of inflammation of other parts of the respiratory tracts or ears are usually seen. Sometimes the infection may spread to the bronchi and lungs. To properly assess pathological changes of the larynx beside the general and laryngological examinations direct visualization of the larynx on endoscopy, fiberoscopy and laryngoscopy is indicated. The most general symptoms of laryngitis occur also in other disorders of the larynx which occur with dyspnoea like the foreign body of the larynx. So the precise diagnosis is a good base for planning of further treatment. When the symptoms of laryngitis occur at under 6 months of age or are prolonged or recurrent, a congenital defect of the larynx should be suspected, i.e. laryngeal web or haemangioma of the larynx. In these cases direct examination of the larynx is an urgent necessity, because the treatment of these disorders varies.
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