Laryngitis is an acute inflammation of the laryngeal mucosa of viral or sometimes bacterial origin.
Common clinical signs:
– Inspiratory dyspnea, more or less indrawing, stridor more or less, with cough and hoarse voice.
– Gravity Signs: sweating, tachycardia, cyanosis, impaired consciousness.
Examine the child in a sitting position, do not lie: there is a risk of airway obstruction.
Etiology and treatment:
In children over 6 months:
Case 1: dyspnea occurred rapidly (within hours)
– Acute epiglottitis caused by Haemophilus influenzae: sudden onset, severe dyspnea, drawing, high fever, cervical lymphadenopathy. The child is sitting, breathing mouth open, drooling saliva clear that he can not swallow because of dysphagia. The general state is altered.
• Avoid examination of the larynx (risk of respiratory arrest), do not lie down, keep sitting.
• To breathe in a humid atmosphere (bowl of water or a wet towel).
• Anti-biotherapy :
ceftriaxone IM: 100 mg / kg / day in 2 divided doses for 5 days
in the absence of,
ampicillin IV: 200 mg / kg / day in 3 divided in 4 injections, then take oral treatment as soon as possible with
amoxicillin PO: 100 mg / kg / day divided into 2 or 3 doses to complete 5 days of treatment.
or
chloramphenicol IV: 100 mg / kg / day in 3 injections, then change to oral treatment as soon as possible, the same doses to complete 5 days of treatment.
• In cases of severe respiratory distress: intubation in a specialized, otherwise tracheotomy.
– Spasmodic laryngitis amid rhinitis or measles, night and suddenly, coughing followed suffocation access and an inspiratory dyspnea, possibly accompanied by stridor, voice still hoarse after access. No fever.
• Monitor the child, put it quietly and do breathe in a humid atmosphere (bowl of water or a wet towel).
• clearing the nasopharynx by washing with sodium chloride 0.9% or Ringer’s lactate, 4-6 times / day.
• Eventually, antihistamines for 3 days: promethazine PO
Children 2 to 5 years 5 to 15 mg / day taken 1-2
Children from 5 to 10 years: 10 to 25 mg / day taken 1-2
Children over 10 years: 25-50 mg / day in 1-2 doses or chlorphenamine PO
Children from 1 to 2: 1 mg 2 times a day
Children 2 to 6 years: 1 mg 4-6 times a day
Children 6 to 12 years: 2 mg 4-6 times a day
Adult: 4 mg 4 to 6 times per day
• In case of severe dyspnoea: dexamethasone IM: 0.1 to 0.2 mg / kg dose or hydrocortisone IM: 1 mg / kg single dose 2nd case: dyspnea appeared gradually (over 24 hours)
– Form subglottic viral: the beginning is often nocturnal dyspnea is typical, the cry is hoarse and coughing, expiration is free.
• Monitor the child, put it quietly and do breathe in a humid atmosphere (bowl of water or a wet towel).
• IM dexamethasone: 0.1 to 0.2 mg / kg or hydrocortisone IM: 1 mg / kg to renew after 30 minutes if necessary.
• Antibiotic unnecessary, except in cases of superinfection (amoxicillin or cotrimoxazole).
• If aggravation: intubation if possible, otherwise tracheotomy.
However eliminate diphtheria (see diphtheria, page 55) and a retro-pharyngeal abscess.
In adults:
– Viral Origin: treatment is symptomatic (paracetamol or acetylsalicylic acid PO).
– Very rarely epiglottitis caused by Haemophilus influenzae, diphtheria, retro-pharyngeal abscess: same clinical signs and treatment in children.
– Think also with laryngeal tuberculosis in a patient with tuberculosis, laryngeal cancer, especially in smokers.
