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Laryngeal infections

  1. Acute laryngotracheobronchitis (croup) also called pseudo membranous laryngitis.
    1. Affects the larynx, trachea and bronchi
    2. Organism: Viral Parainfluenza type I and II with superimposed bacterial infection [Hemolytic Streptococci]
    3. Age group; 6 mth -3 yrs
    4. Male> female
    5. Pathology:
      1. Production of thick tenacious mucus which can hardly be expectorated - Pseudomembranes
      2. Swelling of loose areolar tissue of subglottic region
    6. Clinical Features:
      1. Onset -gradual
      2. Fever(39-40oC).
      3. Dry, harsh cough (Croupy cough)
      4. Hoarseness and inspiratory stridor          
      5. Tenacious secretions and thick crusts     
      6. Mucosal swelling esp of the sub-glottic area Airway obstruction
        Radiological sign → Steeple sign on x-ray neck AP view (STEEPLE) --> (MCQ)
  1. Hospitalization
  2. Penicillins (ampicillin)
  3. I/v fluids
  4. I/v steroids : to reduce edema especially when child in distress
  5. Humidified air to soften crusts
  6. Nebulization
  7. Racemic Adrenaline via a respirator
  8. Intubation / tracheostomy may be needed
  1. Acute Epiglottitis (syn. Acute supraglottitis/ supraglottic laryngitis)
    Acute inflammatory condition of the supraglottic structures:
    1. Epiglottis          
    2. Aryepiglottic fold  
    3. Arytenoids
Organism; H. Influenza - type B     


Extra Edge. Acute epiglottitis in children is caused by Haemophilus influenzae type B. It produces a typical “Thumb sign” on lateral X-ray film. Ampicillin was considered the drug of choice but now many organisms have become resistant to it and ceftriaxone is preferred.


  1. Age group : 2 - 7 years
  2. Onset: abrupt
  3. Rapid progression : over a few, hours
  4. High grade fever
  5. Fever (sometimes> 40 degree)
  6. Cough is absent due to o dynophagia
  7. Drooling of saliva
  8. Voice not affected or may be plummy or muffled
  9. Child prefers sitting position (tripod sign)
  10. X-ray of soft tissues of neck – thumb sign
Sign: Red swollen epiglottis is seen on depressing the tongue. Care is to be taken when depressing the tongue- Fear of glottic spasm à Better avoid this examination
  1. Hospitalization         
  2. I/v antibiotics (ampidllin/chloramphenicol/cefotaxime)
  3. I/v steroids              
  4. Hydration to be maintained         
  5. Humidification/02
  6. Intubation/ tracheostomy --> Emergency tracheostomy may be required.
Table: Differences between acute epiglottitis and acute laryngo-tracheo-bronchitis in children
                                  Acute epiglottitis                      Acute laryngo-tracheo-bronchitis    (or group)
Causative organism    Haemophilus influenzae type B            Parainfluenza virus type I and II
Age                           2-7 years Supraglottic                        3 months to 3 years
Pathology                  Supraglottic larynx                             Subglottic area
Prodromal symptoms   absent                                              Present
Onset                         Sudden                                             Slow
Fever                         High                                                  Low grade or no fever
Patient’s look              Toxic                                                 Non-toxic
Cough                        Usually absent                                   Present, (Barking seal-like)
Stridor                       Present and may be marked                Present
Odynophagia              Present, with drooling of secretions      Usually absent
Radiology                   *Thumb sign on lateral view                Steeple sign on anteroposterior view of neck
Treatment                 Humidified oxygen, third generation       Humidified O2 tent, steroids
                                 cephalosporin (ceftriaxone) or        

‘Examination of larynx and radiographs are avoided lest complete obstruction is precipitated. Examination is done in the operation theatre where immediate intubation can be done.

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