Acute Disorders of the Larynx

Acute laryngitis—adults Acute laryngitis is more common in winter months and is usually caused by acute coryza (common cold) or influenza. It is predisposed to by vocal over-use, smoking or drinking of spirits. If factors from both groups coexist —the heavy smoker with a cold, shouting abuse at the referee on a winter’s afternoon—acute laryngitis is (fortunately for everybody else) sure to follow. CLINICAL FEATURES Clinical features include aphonia (the voice reduced to a whisper) or dysphonia (a painful croak) and pain around the larynx, especially on coughing. Examination by indirect laryngoscopy shows the larynx to be red and dry, with stringy mucus between the cords. TREATMENT 1 Total voice rest. 2 Inhalations with steam. 3 No smoking. 4 Antibiotics are rarely necessary. Acute laryngitis—children As a result of acute upper respiratory infection, laryngitis may develop.This may lead to airway obstruction. CLINICAL FEATURES 1 Unwell. 2 Harsh cough. 3 Hoarse voice or aphonia. This early stage will often respond to paracetamol and a steamy environment. If oedema develops within the limited space of the subglottis, stridor may supervene.This combination of acute laryngitis and stridor is known as croup. If there is significant or worsening airway obstruction, the child should be admitted to hospital, preferably where paediatric intensive care facilities are available. Acute epiglottitis More common in North America than the UK, acute epiglottitis is a localized infection of the supraglottic larynx usually by Haemophilus influenzae. It causes severe swelling of the epiglottis, which obstructs the laryngeal inlet. In children it constitutes the most urgent emergency—the child may progress from being perfectly well to being dead within the space of a few hours on account of airway obstruction. Fortunately, it has now become very rare in the UK because of the widespread use of HIB vaccine. CLINICAL FEATURES The child will become unwell, with increasing dysphagia and a quack-like cough. Stridor will develop rapidly and the child will prefer to sit up, leaning forward to ease his airway. If the diagnosis is suspected and even though symptoms may be mild, the child should be admitted at once to hospital. At one time tracheostomy was the treatment of choice but most cases are now managed by endotracheal intubation and therapy with chloramphenicol, which will result in rapid resolution. In adults the pain is severe and is worsened on swallowing. It is slower to develop and to resolve than in children. Respiratory obstruction is less likely to occur, but may do so with a fatal result. Laryngotracheobronchitis This condition occurs in infants and toddlers and is a generalized respiratory infection, probably viral in origin. In addition to laryngeal oedema, there is the production of thick tenacious secretions, which block the trachea and small airways. It is of slower onset than acute epiglottitis and there is a harsh, croupy cough. Mild cases will settle on treatment with humidified air, but more severe cases will require airway support and possible ventilation. Laryngeal diphtheria Laryngeal diphtheria is rarely seen now in the UK.The child is ill and usually presents the clinical picture of faucial diphtheria. Stridor suggests the spread of membrane to the larynx and trachea. TREATMENT 1 Antitoxin. 2 General medical treatment for diphtheria. 3 Tracheostomy (q.v) may be indicated.

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