laryngotracheal infections balasubramanian thiagarajan drtbalu's otolaryngology online 1
DESCRIPTION
Etiology URI Neck space infections GERDS Non specific inflammation (sarcoidosis, Wegner’s granomas) Allergy Inhalation of toxic fumes drtbalu's otolaryngology online 3TRANSCRIPT
drtbalu's otolaryngology online
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Laryngotracheal infectionsBALASUBRAMANIAN THIAGARAJAN
drtbalu's otolaryngology online
2Acute laryngitis
Acute infections involving larynx Can be bacterial / viral Part of upper / lower respiratory infections Smoking / exposure to pollutants – risk factors Voice abuse / laryngeal trauma. Posterior glottis commonly involved GERDS
drtbalu's otolaryngology online
3Etiology
URI Neck space infections GERDS Non specific inflammation (sarcoidosis, Wegner’s granomas) Allergy Inhalation of toxic fumes
drtbalu's otolaryngology online
4Clinical features
Change / loss of voice Sore throat Otalgia Difficulty in swallowing / painful swallow Tender larynx Cervical adenopathy Difficulty in breathing
drtbalu's otolaryngology online
5Indirect laryngoscopy
Inflammation involving mucosa of supraglottis / glottis / subglottis
Vocal cord reddish & oedematous Pooling of saliva is there is
odynophagia
drtbalu's otolaryngology online
6Management
Absolute voice rest Avoidance of irritants / fumes Avoidance of gargling Antibiotics reserved only for severe bacterial infections. Moraxella
catarrhalis is common. Erythromycin drug of choice
drtbalu's otolaryngology online
7Acute epiglottitis
Also known as supraglottitis Epiglottis is commonly affected Lingual tonsils, aryepiglottic folds and ventricular bands may also be
involved Can involve all age groups Can progress rapidly in children causing airway obstruction Hemophilus influenza is the commonest organism involved
drtbalu's otolaryngology online
8Clinical features
Drooling Painful swallowing Voice change Inflamed epiglottis, aryepiglottic folds, arytenoids and ventricular bands Cervical adenopathy
drtbalu's otolaryngology online
9Radiology
Enlarged epiglottis “Thumb sign” Absence of deep well defined
vallecula “Vallecular sign”.
drtbalu's otolaryngology online
10Complications
Respiratory distress Epiglottic abscess Internal jugular vein thrombosis
drtbalu's otolaryngology online
11Management
If a child should be admitted Airway compromise – Tracheostomy Antibiotics – III generation cephalosporins
drtbalu's otolaryngology online
12Croup
Laryngotracheal bronchitis “Sore throat with hoarse breathing” Children 6 months – 3 yrs Uncommon in adults Subglottic oedema Biphasic stridor
drtbalu's otolaryngology online
13Etiology
Commonly viral Paramyxovirus, parainfluenza virus Types I and II have been implicated In adults herpes simplex have been implicated
drtbalu's otolaryngology online
14Clinical features
Cough Sore throat Malaise Mild fever Inspiratory stridor
drtbalu's otolaryngology online
15X-ray chest
Narrowing seen at the level of subglottis
Steeple sign / pencil sign
drtbalu's otolaryngology online
16Management
Self limiting disease Patient improves within a day Completely recovers in 3-4 days Oxygenation Steroids Adrenaline nebulisation
drtbalu's otolaryngology online
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Score 0 1 2 3 4 5Inspiratory stridor
- Audible with steth
Audible without steth
Retraction - Mild Moderate SevereAir entry Normal Decrease
dSeverely decreased
Cyanosis None With agitation
At rest
Conscious level
altered
Westley score
Maximum – 172-3 mild croup
4-7 moderate croupAbove 8 severe croup
drtbalu's otolaryngology online
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Thank you