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Acquired Laryngotracheal Disease
Published in Raymond W Clarke, Diseases of the Ear, Nose & Throat in Children, 2023
Acute laryngotracheobronchitis (ALTB) is commonly referred to as ‘croup’, which describes the typically harsh cough which accompanies a common viral infection in children. It is more prevalent in the winter months and can be due to one of a variety of viruses including the respiratory syncytial virus (RSV) or a parainfluenza virus. The usual age of onset is about 18 months. The mucosa of the larynx, trachea and bronchi becomes suf-fused and oedematous with a marked reduction in the calibre of the airway and the child becomes progressively more distressed. In severe cases stridor is marked, leading on to respiratory failure. Mild cases can be managed at home. The response to systemic steroids (oral dexamethasone 0.4 mg per kg) is usually very rapid, but more severe cases will need hospital admission for observation with serial monitoring (pulse oximetry), nebulised adrenaline, oxygen therapy and sometimes, in exceptional circumstances, airway support including ET intubation.
Communication Stations
Published in Adnan Darr, Karan Jolly, Jameel Muzaffar, ENT Vivas, 2023
Wai Sum Cho, Anna Slovick, Jameel Muzaffar, Adnan Darr
Part 3: Following surgery, the patient developed stridor and significant respiratory distress in recovery. Flexible nasendoscopy showed bilateral vocal cord palsy. You decided to perform a tracheostomy and insertion of a nasogastric feeding tube. Explain your surgical findings and management plan to the family membersPoints to cover: Bilateral vocal cord palsy may be temporary or permanentTracheostomy likely temporary but may be permanent depending on recovery, swallow and aspiration riskDiscuss about swallowing assessments and potentially removal of feeding tubeDiscuss possibility of going home with tracheostomy but dependent of recovery and support available for patient and family from airway nurse specialist
An anxious insomniac
Published in Tim French, Terry Wardle, The Problem-Based Learning Workbook, 2022
Stridor is a sign of extra-thoracic airway obstruction and is a medical emergency. If surgery is not immediately available, the patient should be anaesthetised, intubated and ventilated. Intubation becomes progressively more difficult as the trachea becomes oedematous, distorted and compressed.
Case report of a laryngeal tuberculosis during pregnancy – challenges in diagnosis and management
Published in Acta Oto-Laryngologica Case Reports, 2023
Julian Pfäffli, Amina Nemmour, Philipp Kohler, Sandro J. Stoeckli
Regarding its pathogenesis, laryngeal TB can be divided into primary laryngeal TB from direct invasion of bacilli into the larynx or secondary laryngeal TB due to direct bronchogenic spread from advanced pulmonary TB or via hematogenous or lymphatic spread from extrapulmonary sources. While older publications from the 1940s reported a vast majority of secondary laryngeal TB, a more recent review revealed a higher proportion of primary laryngeal TB. Due to its rarity and unspecific symptoms, laryngeal TB is easily misdiagnosed. Symptoms may mimic common disorders like laryngopharyngeal reflux (LPR) or malignancy. The most common symptoms of laryngeal TB are dysphonia (96%), weight loss (47%), cough (38%), dysphagia (26%) and odynophagia (25%). Stridor has been described in 9% of the cases with a potential need of tracheotomy for safe airway management [3].
Prognostic factors and importance of recognition of adult croup
Published in Acta Oto-Laryngologica, 2018
Tomoyasu Tachibana, Yorihisa Orita, Takuma Makino, Yasutoshi Komatsubara, Yuko Matsuyama, Yuto Naoi, Michihiro Nakada, Yasuharu Sato, Kazunori Nishizaki
Child croup is often managed safely on an outpatient basis, and hospitalization and intubation are only required in 2% and 0.5–1.5%, respectively [8]. On the other hand, as AC patients often present in severe condition [3,6], some reports have indicated that AC should be managed by hospitalization or admission to the Intensive Care Unit (ICU) even for patients who do not need intubation [2,7]. Stridor has been reported as a prognostic factor for severe croup [1]. In the past 14 AC patients, stridor was observed in eight patients. Of these, six patients (75.0%) required airway intervention and three (37.5%) needed tracheostomy. In the present study, stridor was observed in only one case (5.6%), and no cases required airway intervention. Detailed observation of the subglottic region by laryngoscopic examination might help to detect severe cases which requires airway intervention.
Prehospital Pediatric Respiratory Distress and Airway Management Training and Education: An NAEMSP Position Statement and Resource Document
Published in Prehospital Emergency Care, 2022
John Lyng, Matthew Harris, Maria Mandt, Brian Moore, Toni Gross, Marianne Gausche-Hill, J. Joelle Donofrio-Odmann
In addition to nasopharyngeal issues, younger pediatric patients and patients with various congenital diagnoses may have larger tongues, smaller jaws, larger occiputs, and increased secretions that may also impede airway patency (5). Further, children often present with stridor due to anatomic subglottic narrowing and smaller diameter of the trachea. Multiple diagnoses can lead to stridor including infectious processes, congenital malformations, anaphylactic reactions, or foreign body obstruction. Education on airway positioning, jaw thrusting, suctioning, proper selection of oropharyngeal airway size and indications for use, and selection of inhaled medications appropriate for treatment of stridor are recommended.