28. Acute and chronic infections of the larynx, acute epiglottitis, phlegmonous epiglottitis, abscess of the epiglottis

• Acute laryngitis
  • Benign disorder
  • Also called "false croup"
  • < 3 weeks duration
  • Etiology
    • Infectious
      • Descended URTI
      • Viral
        • Rhinovirus
        • Adenovirus
      • Bacterial superinfection
    • Non-infectious
      • Vocal strain
      • Airborne irritants
  • Clinical features
    • Hoarseness
    • Dry cough
  • Related disorders
    • Croup – laryngotracheitis
    • Epiglottitis
  • Diagnosis
    • Laryngoscopy – erythema, oedema of larynx
  • Treatment
    • Self-limiting
    • Vocal rest
    • Steam inhalation
    • Antibiotics if bacterial

• Chronic laryngitis
  • > 3 weeks duration
  • Etiology
    • Ascending or descending inflammation
    • GERD
    • Smoking
    • Recurring URTI (postnasal drip)

• Epiglottitis
  • Severe phlegmonous infection, quickly progressing
  • Important to consider it in all children with stridor
  • Less common after H. influenzae vaccine
  • Mostly in young children
  • Etiology
    • H. influenzae
    • S. pneumoniae
  • Clinical features
    • High fever
    • Inspiratory stridor
    • Odynophagia
    • Drooling
    • Leaning forward
    • No cough
  • Management
    • Urgent to hospital
    • Airway may collapse rapidly, must be prepared to intubate, no inspection of the pharynx before you're prepared
    • Visualisation of inflamed epiglottis by laryngoscopy
    • IV antibiotics
  • Complications
    • Abscess (rare)