Acute laryngitis (false croup) in children

Acute laryngitis in children (synonyms: croup, false croup, laryngeal stenosis, stenosing laryngitis, lumbar lining, acute obstructive laryngitis) because of the small size of the larynx quickly spreads into the underlay space, which is characterized by favorable conditions for the development of the inflammatory-edematous process, that in this area in children younger than 6-7 years old is a loose connective tissue in which the edematous-infiltrative processes characteristic for lumbar lining are developed.

Acute laryngitis and laryngotracheitis - acute inflammation of the mucous membrane of the larynx and trachea.

Acute stenosing laryngitis is a laryngitis with an inflammatory edema of the mucous membrane and submucosal tissue of the subglottic region of the larynx, resulting in a narrowing of the larynx of the larynx or larynx and trachea.

To this form of the larynx is often joined reflex spasms of the larynx, manifested by the obstruction of the airways (stenosis of the larynx), very similar in its clinical picture with respiratory failure in diphtheria, hence - the name of this condition is false croup. According to the French children's otolaryngologist Mulonge, approximately 85-90% of cases of breathing disorders in acute banal laryngitis in children are caused by liningitis. VE Ostapkovich during the epidemic of influenza that raged in Russia in 1952, reports 80% of the liningitis of the laryngitis that have arisen in patients with influenza. Lumbar laryngitis most often occurs in children aged 2-3 years. According to the Romanian otorhinolaryngologist N. Kostinesku, in 21% of cases, lumbar lining was observed in infants, 52% in children aged 1-3 years, 18% at 3-6 years of age, and 9% after 6 years.

Acute laryngitis (false cereal) in children: ICD code 10

• J04 Acute laryngitis and tracheitis.
• J04.0 Acute laryngitis.
• J04.4 Acute laryngotracheitis.
• J05.0 Acute obstructive laryngitis (croup).

[1], [2]

Epidemiology

The highest incidence of acute laryngitis was noted in children aged 6 months to 2 years. At this age, it is observed in 34% of children with acute respiratory disease.

[3], [4]

Causes of acute laryngitis in children

The etiology of acute laryngitis is predominantly viral. The leading etiological role is played by parainfluenza viruses, mainly of the first type, followed by PC viruses, influenza viruses, mainly type B, adenoviruses. Less common are herpes simplex virus and measles. Bacterial infection plays a lesser role in the etiology of acute laryngitis, but. As a rule, leads to a more severe current. The main causative agent is a hemophilic rod (type b), but it can also be staphylococcus aureus. Streptococcus group A. Pneumococcus. In previous years, before the mandatory vaccination of children against diphtheria, the main causative agent was a diphtheria stick, which has now become a rarity.

Podsklladochnym laryngitis fall ill almost exclusively in the cold season, in Russia, more often between October and May, it often appears as a complication of acute rhinopharyngitis, adenoiditis, influenza, measles, less often chicken pox, whooping cough, etc. According to statistical data of the Iasi Otorhinolaryngology Clinic (Romania) 64% of cases of laryngitis are caused by influenza and 6% by measles. Most of the lumbar lining arises in children with exudative diathesis, spasmophilia, avitaminosis (rickets) and artificially fed.

As the etiological factors are the influenza virus, staphylococcus aureus, streptococcus, pneumococcus. Influenza virus, according to VE Ostapkovich (1982), serves as a kind of protector, preparing the soil for activating and multiplying the banal microbiota by provoking capillaritis, exudation, the formation of false films. The most severe forms of nodding laryngitis are observed with the activation of staphylococcal infection, in which pulmonary complications occur with a high mortality rate (in the middle of the 20th century lethality with staphylococcal laryngitis complicated by pneumonia reached 50%).

What causes acute laryngitis?

[5], [6], [7], [8], [9]

Symptoms of acute laryngitis in children

Acute laryngitis usually develops on the 2nd-2nd day of an acute infection of the upper respiratory tract and is characterized by hoarseness. When acute laryngeotraheitis joins a sonorous "barking" cough. In the lungs - wired dry wheezing rales, they are listened to mainly by inhalation. The child is excited.

Acute stenosing laryngitis characterizes a triad of symptoms - voice hoarseness, sonorous "barking" cough and noisy breathing - the stridor of the larynx, which manifests itself mainly as inspiratory dyspnea. In addition, dry whistling wheezing can be heard, mainly on inhalation. The child shows a pronounced anxiety, excited. The temperature response depends on the reactivity of the child's organism and on the causative agent of acute laryngitis. So. With parainfluous etiology and PC-viral temperature reaction is moderate, with influenza aetiology the temperature is high. During the day, inspiratory dyspnoea and the severity of airway obstruction vary from almost complete disappearance to severe, but are most pronounced at night.

Signs of liningitis in most cases are typical and concern primarily children, whose appearance before the crisis does not indicate the presence of any disease in them or from an anamnesis it is known that they are currently experiencing phenomena of rhinitis or adenoiditis. As already noted above, lumbar lining is characterized by an attack of false croup - a special form of acute lumbar ligation, characterized by recurrent and more or less rapidly passing signs of acute stenosis of the larynx;

Occurs mainly in children aged 2 to 7 years - which is characterized by a sudden onset; arises more often at night, as a rule, in healthy before that children or suffering ORZ. The onset of an attack at night is explained by the fact that the horizontal position increases swelling in the underlayment space and the conditions for coughing up mucus worsen. It is also known that at night the tone of the parasympathetic nervous system (the vagus nerve) increases, which leads to an increase in the secretory activity of the mucous glands of the upper respiratory tract, including the larynx, trachea and bronchi.

With false croup, a child wakes up at night with signs of rapidly growing suffocation, accompanied by a marked violation of breathing, objectively manifested signs of inspiratory dyspnea - drawing in on the inspiration of the jugular and supraclavicular pits, intercostal spaces, cyanosis of the lips and nasolabial triangle, motor anxiety. VG Ermolaev described a respiratory symptom characteristic only of false croup, consisting in the fact that between the exhalation and the inspiration there is a time interval. Characteristically, this symptom is not observed with true croup, in which the breathing cycles follow continuously one after another without intervals, and the breath begins! Even earlier than exhalation, and the breathing itself is noisy, stridorous. During the attack of false croup, the sonority of the voice remains, which indicates that there is no lesion of the vocal folds - a symptom not characteristic of diphtheritic laryngitis. At the same time there is a dry, hoarse, barking cough.

Cough is a consequence of reflex excitation of the cough center and arises as a reflection of a protective mechanism that prevents congestion and promotes rejection and release of inflammation products (mucus, omitted epithelium, crusts, etc.) from the larynx and underlying respiratory tract. There are two types of cough: productive (useful) and unproductive (not useful). The productive cough should not be suppressed if it is accompanied by the secretion of secretion, inflammatory exudate, transudate and agents that have got from the environment into the respiratory tract. In all other cases it is called unproductive, and sometimes causing additional irritation of the larynx.

The presence of a hoarse cough and ringing of the rivers is an almost pathognomonic sign of the lumbar lining. These phenomena can last from a few minutes to 2-3 hours; the attack is completed by the release of viscous sputum. The next morning the child wakes up in the usual state. The attack can repeat the same night or the next; in some cases, it does not repeat. If you can make an indirect laryngoscopy, you can see under the normal form of vocal folds hyperemic, edematous ridges; during laryngospasm, the vocal folds on the exhalation are in a closed or almost closed state, and on the inhalation they slightly diverge, while the width of the respiratory gap does not exceed 2 mm. A similar picture appears with direct laryngoscopy.

The temperature reaction during an attack is not expressed and dissociates with a frequent pulse. With two or three seizures per night, there is a large load on the myocardium, which can lead to collapse.

Among the possible complications are the most severe bronchopneumonia and laryngotraheobronchitis, in which the prognosis regarding life is very serious.

Symptoms of acute laryngitis

Classification of acute laryngitis

Acute laryngitis is divided by etiology into viral and bacterial, by the stage of stenosis of the larynx - to compensated laryngitis, subcompensated, decompensated and laryngitis in the terminal stage. In addition, the nature of the flow is allocated uncomplicated and complicated laryngitis, as well as recurrent laryngitis and descending. The latter occurs with diphtheria laryngitis, when the inflammatory process spreads to the mucous membrane of the trachea, bronchi and bronchioles.

[10], [11], [12]

Diagnosis of acute laryngitis in children

Diagnosis of the disease is based on clinical data, with stenosing laryngitis - on the data of direct laryngoscopy.

In acute simple laryngitis, there is no need for laboratory testing.

With stenosing laryngitis, the acid-base state of the blood is determined and the peripheral blood is analyzed.

• The acid-base state of blood in the first stage is without significant changes.
• In the II stage, the partial pressure of oxygen in the blood is moderately reduced, the partial pressure of carbon dioxide is not changed.
• In the third stage, the partial pressure of oxygen is lowered, the pressure of carbon dioxide is increased, respiratory or mixed acidosis is noted. There is a decrease in oxygen saturation.
• In IV, terminal, stage marked acidosis. The oxygen saturation is sharply reduced.

The diagnosis is made on the basis of the above described clinical signs and data of direct laryngoscopy. Differentiate the false croup from the reflex laryngospasm that occurs in children aged 2-3 years, more pronounced, but also shorter, which is not accompanied by inflammatory phenomena barking coughing, but can be accompanied by general convulsions and signs of spasmophilia. Banal acute laryngitis, in contrast to the false croup, is characterized by a certain temporary development of dysphonia. The main danger in the occurrence of laryngospasm is the loss of diphtheria of the larynx, therefore, in all cases of obstructive laryngitis, this infectious disease should be excluded. False croup differs from diphtheria in that stenosis grows gradually in the latter, as well as the signs of dnephosis gradually increase, reaching full aphonia, and in the larynx, characteristic diphtheritic raids spreading to all of its departments are observed.

Differential diagnosis should also take into account the possibility that the child has a number of pathological conditions that can manifest laryngeal spasm syndrome (congenital stridor, developmental larynx, laryngeal lesions in congenital syphilis, neurotoxicosis in severe nephropathy, macroglossia, tongue lancing, congenital laryngeal tumors, , papillomatosis of the larynx, mediastinal tumor, adenopathy, thymus hypertrophy, asthmatic syndrome, acute pneumopathy).

Diagnosis of acute laryngitis

[13], [14], [15],

Treatment of acute laryngitis in children

Therapy of acute laryngitis is aimed at preventing the stenosis of the larynx, when it occurs - to restore the patency of the larynx.

In acute laryngitis it is necessary to explain to parents that it is necessary to create an environment that excludes negative emotions, because the excitement of the baby can be an additional factor that promotes and enhances stenosis of the larynx. It is necessary to ensure the patient access to fresh air in the room. Where it is located, and moisten the air in the room. It is useful to give a sick child a warm alkaline drink (milk with soda: 1/2 teaspoon of soda for 1 glass of milk, milk with mineral water "Borjomi").

As an initial aid, an attack of false croup can be attempted to eliminate the alternative irritation of other sensitive nerve elements. For example GL Nazarova (1960) recommends pressing with a spatula or a teaspoon on the root of the tongue; the resulting gag reflex usually relieves the spasm of the glottis. Sometimes it is enough to tickle something in the nose to cause a sneeze reflex.

From other methods apply warming compresses on the larynx and chest area, hot foot baths, mustard plasters on the thoracic and interscapular area and to the gastrocnemius muscles, the cans on the back. Some doctors recommend that in the next few nights awaken the child and give him a sweetened drink, alkaline mineral water or fruit juice to prevent repeated attacks. In the last century, per os Ipecacuan and apomorphine were prescribed in expectorant doses, with strong cough for older children - codeine, libexin.

With non-productive cough, antitussives are used. They are divided into two groups: drugs of peripheral and central action. When coughing caused by irritation of the larynx (acute catarrhal laryngitis, lumbar lining, false cereal, etc.), medicines are used in the form of syrups and flat cakes (to children of early age - in the form of special sticks for sucking, which have a softening effect). When coughing, the source of which is irritation of the trachea and lower respiratory tract, inhalation of aqueous medicinal aerosols and thermal procedures are used. As antitussive drugs of central action, morphine-like compounds (codeine, folcodine, noscapine, dextromethorphan, kodelak, koldrin, etc.) are used. And substances differing in structure from opiates (libexin, tusuprex, etc.). At the same time, antihistamines are prescribed (H1 receptor blockers with sedative and choliolytic properties), for example, diphenhydramine (dimedrol), which suppresses cough, inhibiting the excitability of the cough center, and enhances the effect of other antitussive agents of peripheral action.

In cases of laryngeal edema, along with antihistamines (dimedrol, diazolin, suprastin), glucocorticoid drugs (dexamstasone, dexaven), as well as anti-sedation and sedatives (calcium chloride, calcium gluconate, phenobarbital, etc.) are prescribed. Older children are prescribed laryngeal spraying (5% cocaine hydrochloride solution in a dilution of 1: 200 in a mixture with 3% solution of ephedrine hydrochloride), as well as installation of a 0.1% solution of epinephrine. To prevent back inflammation in the first days, antibiotics are prescribed in a mixture with hydrocortisone (500,000-1,000,000 units of penicillin ED + 150-200 mg of cortisone daily).

How is acute laryngitis treated (false croup)?

What prognosis does acute laryngitis have in a child?

Prognosis for acute laryngitis, laryngotracheitis is favorable. When stenosing laryngitis is also favorable for early treatment. With late-onset treatment, especially in the terminal stage, a lethal outcome is possible.