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American Family Physician Feb 2004Viral croup is the most common form of airway obstruction in children six months to six years of age. The frightening nature of croup often prompts parents and... (Review)
Review
Viral croup is the most common form of airway obstruction in children six months to six years of age. The frightening nature of croup often prompts parents and caregivers to seek physician consultation. For children with mild croup, symptomatic care and mist therapy may be all that is necessary. Epinephrine has been used for decades to treat more severe cases of croup, but recent meta-analyses have found that glucocorticoid use is associated with shorter hospital stays, improvement in croup scores, and less use of epinephrine. Studies have shown that treatment with 0.6 mg per kg of oral dexamethasone is as effective as intramuscular dexamethasone or 2 mg of nebulized budesonide. Oral dexamethasone in dosages as low as 0.15 mg per kg also may be effective. While more studies are needed to establish guidelines, oral dexamethasone can be used to treat mild to moderate croup with close follow-up and instructions for further care, if needed.
Topics: Child; Child, Preschool; Croup; Diagnosis, Differential; Hospitalization; Humans; Infant; Prognosis
PubMed: 14971835
DOI: No ID Found -
Archives of Disease in Childhood Mar 1983During a 2-year period, 7 children were seen with a severe form of laryngotracheobronchitis associated with sloughing of the respiratory epithelium and profuse...
During a 2-year period, 7 children were seen with a severe form of laryngotracheobronchitis associated with sloughing of the respiratory epithelium and profuse mucopurulent secretions. We have called this condition pseudomembranous croup. The children had severe upper airways obstruction, appeared toxic with high fever, and were older than the typical age group for viral laryngotracheobronchitis. Lateral x-ray films of the airways showed subglottic narrowing and often these suggested the presence of radio-opaque foreign material in the tracheal lumen. At endoscopy, in addition to pseudomembrane in the subglottic region and trachea, there was thick mucopus and debris, and in some cases these changes extended into the bronchi. An artificial airway was required in all except one, and even after intubation it proved difficult to maintain the airway. Staphylococcus aureus was the most common pathogen isolated from tracheal cultures but other organisms were grown.
Topics: Airway Obstruction; Child; Child, Preschool; Croup; Diagnosis, Differential; Female; Humans; Infant; Intubation, Intratracheal; Laryngitis; Male; Tracheotomy
PubMed: 6838248
DOI: 10.1136/adc.58.3.180 -
Lin Chuang Er Bi Yan Hou Tou Jing Wai... Dec 2023This paper focuses on the diagnosis and treatment of disorders of laryngeal airway in children, including congenital anomalies, infection, and tumor of the larynx to...
This paper focuses on the diagnosis and treatment of disorders of laryngeal airway in children, including congenital anomalies, infection, and tumor of the larynx to provide a new technology for managing these diseases. Based on the characteristic of them, the pediatric upper airway is dedicated to the clinical evaluation of airway obstruction and the assessment of the compromised pediatric airway, including clinical evaluation of symptoms, diagnostic endoscopy, and imaging examination. Information on endoscopic techniques used for dealing with different degrees of pediatric airway comprised is provided, also this techniques could diagnose what kinds of airway disorder. For example, determining the a particular laryngeal cleft at the initial otolaryngology encounter, flexible laryngoscopy should be performed. In order to define the extent of any identified cleft, the rigid bronchoscopy should be completed to evaluate for classification of laryngeal cleft including typeⅠ, Ⅱ, Ⅲa, Ⅲb, Ⅳa, Ⅳb under general anesthesia. The decision to pursue any therapy for the disorders of laryngeal airway in children should be based on the severity of the patient's symptoms, endoscopic and imaging examination. There are two medical treatments including nonsurgical therapy and surgical therapy. For example the laryngeal cleft, approximately half of type 1 and select type 2 patients can be managed entirely with nonsurgical therapy. Medical management is multifaceted. Under recommendations from the feeding team, a modified diet with thickened feeds and possibly altered feeding position should be initiated. Endoscopic surgical repair is the current gold standard for definitive repair of type 1, the majority of type 2, and selected type 3 clefts. Finally, information on new techniques used into the future for dealing with the diagnosis and treatment of disorders of laryngeal airway in children in this paper.
Topics: Child; Humans; Infant; Larynx; Laryngoscopy; Endoscopy; Bronchoscopy; Congenital Abnormalities
PubMed: 38114307
DOI: 10.13201/j.issn.2096-7993.2023.12.001 -
Archivos Argentinos de Pediatria Jun 2022The larynx is at the aerodigestive crossroads; any pathology that involves it will have an impact on breathing, swallowing and/or the voice. It`s divided into three...
The larynx is at the aerodigestive crossroads; any pathology that involves it will have an impact on breathing, swallowing and/or the voice. It`s divided into three regions: supraglottis (includes epiglottis, ventricular bands and laryngeal ventricles), glottis (space limited by the vocal cords) and subglottis (narrowest area of pediatric airway and the only point of larynx completely surrounded by cartilage: the cricoid ring). Laryngeal obstruction can present as a potentially fatal acute condition or as a chronic process. The main symptom is inspiratory or biphasic stridor. The etiology varies widely according to age and it may be of congenital, inflammatory, infectious, traumatic, neoplastic or iatrogenic origin. We describe the pathologies that cause laryngeal obstruction, either those that occur very often or those which are important for their severity, their guiding symptoms to the presumptive diagnosis, additional studies and treatment.
Topics: Airway Obstruction; Algorithms; Child; Humans; Laryngeal Diseases; Larynx; Pediatrics
PubMed: 35533130
DOI: 10.5546/aap.2022.209 -
The Annals of Otology, Rhinology, and... Feb 2024Superior laryngeal nerve (SLN) block consists of injection of steroid and anesthetic at the internal branch of the SLN entry site. Prior case series have demonstrated...
OBJECTIVE
Superior laryngeal nerve (SLN) block consists of injection of steroid and anesthetic at the internal branch of the SLN entry site. Prior case series have demonstrated beneficial effects on neurogenic cough. SLN blocks have also recently shown benefit for paralaryngeal pain. We describe short-term outcomes for multiple symptoms of irritable larynx syndrome (ILS) including neurogenic cough, dysphonia related to laryngeal hypersensitivity, inducible laryngeal obstruction (ILO), paralaryngeal pain, and isolated globus.
METHODS
Retrospective review from 2 institutions of patients undergoing a single SLN block for the indications listed. Variables include age, sex, indication(s), known vagus neuropathy, and patient-reported outcomes at short-term follow-up.
RESULTS
A total of 209 patients were included (59 males, 150 females; age: 58 ± 13 years). Twenty-six patients (12%) had a history of a vagus nerve injury. Indications included neurogenic cough (n = 149), dysphonia related to laryngeal hypersensitivity (n = 66), paralaryngeal pain (n = 50), ILO (n = 23), and isolated globus (n = 3). Some patients had multiple indications. Significant improvements in patient-reported measures occurred after a single SLN block within 2 to 4 weeks for neurogenic cough (cough severity index; 25.2 ± 11.2 to 19.0 ± 12.8; < .001), dysphonia (voice handicap index-10; 22.1 ± 12.2-18.0 ± 13.3; = .005), and ILO (dyspnea index; 21.0 ± 14.9-14.7 ± 15.7; = .017). Subjective pain improved in 23 of 39 patients with paralaryngeal pain. There was no observed improvement for isolated globus. Presence of known vagal neuropathy or therapy around the time of SLN block did not affect outcome.
CONCLUSION
SLN block can be an effective component of treatment for a variety of ILS symptoms. Patients may experience some improvement after 1 injection.
LAY SUMMARY
Symptoms of irritable larynx syndrome, such as neurogenic cough, paralaryngeal pain, inducible laryngeal obstruction, and dysphonia related to laryngeal hypersensitivity can be challenging to manage. In-office Superior Laryngeal Nerve blocks can serve as a quick, well tolerated, adjunctive treatment with positive short-term outcomes.
LEVEL OF EVIDENCE
4.
Topics: Male; Female; Humans; Middle Aged; Aged; Dysphonia; Larynx; Laryngeal Diseases; Airway Obstruction; Laryngeal Nerves; Cough; Pain
PubMed: 37608685
DOI: 10.1177/00034894231194384 -
Chest Jun 1996Adult croup is a distinct disease entity that probably represents a heterogeneous clinical syndrome. Three cases of adult laryngotracheitis characterized by upper airway...
Adult croup is a distinct disease entity that probably represents a heterogeneous clinical syndrome. Three cases of adult laryngotracheitis characterized by upper airway infection and progression to airway obstruction are illustrated. Close observation and prompt decisions regarding airway intervention are critical in effective management, and complete resolution is expected.
Topics: Adult; Age Factors; Aged; Aged, 80 and over; Croup; Humans; Male
PubMed: 8769531
DOI: 10.1378/chest.109.6.1659 -
American Family Physician Aug 2009Numerous conditions can cause hoarseness, ranging from simple inflammatory processes to more serious systemic, neurologic, or cancerous conditions involving the larynx.... (Review)
Review
Numerous conditions can cause hoarseness, ranging from simple inflammatory processes to more serious systemic, neurologic, or cancerous conditions involving the larynx. Evaluation of a patient with hoarseness includes a careful history, physical examination, and in many cases, laryngoscopy. Any patient with hoarseness lasting longer than two weeks in the absence of an apparent benign cause requires a thorough evaluation of the larynx by direct or indirect laryngoscopy. The management of hoarseness includes identification and treatment of any underlying conditions, vocal hygiene, voice therapy, and specific treatment of vocal cord lesions. Vocal hygiene education is an integral aspect of the treatment of hoarseness in most cases. Referral to a speech-language pathologist for voice therapy may be particularly helpful for patients whose occupation depends on singing or talking loudly or for prolonged periods. Voice therapy is an effective method for improving voice quality and vocal performance in patients with nonorganic dysphonia and for treating many benign pathologic vocal cord lesions. Referral for surgical or other targeted interventions is indicated when conservative management of vocal cord pathology is unsuccessful, when dysplasia or carcinoma is suspected, or when significant airway obstruction is present.
Topics: Adult; Hoarseness; Humans; Laryngitis; Laryngoscopy; Physical Examination; Vocal Cord Paralysis; Voice Quality
PubMed: 19678604
DOI: No ID Found -
Acta Clinica Croatica Dec 2022Hamartoma (from the Greek language, where means defect or an error and denoting a tumor or neoplasm) is a benign tumor-like mass composed of mature tissue or cells...
Hamartoma (from the Greek language, where means defect or an error and denoting a tumor or neoplasm) is a benign tumor-like mass composed of mature tissue or cells that are present in abnormal proportions or show a disorganized arrangement. Hamartomas are rarely seen in the head and neck area and especially rare in the larynx. Only few cases of laryngeal hamartoma have been reported in the literature so far. They are usually manifested by stridor, dysphonia and symptoms associated with airway obstruction. The diagnosis must be confirmed histologically and the method of choice in treatment is complete excision of the lesion. The authors present a case of laryngeal hamartoma of a 43-year-old woman treated for hoarseness and paralysis of the left vocal cord.
Topics: Female; Humans; Adult; Larynx; Neck; Hamartoma; Diagnosis, Differential; Tomography, X-Ray Computed
PubMed: 37868186
DOI: 10.20471/acc.2022.61.04.24 -
The Western Journal of Medicine Mar 1977Treatment techniques for airway obstruction in croup and epiglottitis are reviewed in the medical literature. Series totaling 295 nasotracheal intubations, and 591... (Review)
Review
Treatment techniques for airway obstruction in croup and epiglottitis are reviewed in the medical literature. Series totaling 295 nasotracheal intubations, and 591 tracheostomies were reviewed. There were two deaths attributable to airway complications in 126 patients in whom nasotracheal intubation was carried out. In three patients subglottic granulation tissue and subglottic stenoses developed from short-term nasotracheal intubation. There were no subglottic stenoses or tracheal stenoses reported in the 591 tracheostomies. From this review, it would seem feasible to use nasotracheal intubation for short-term airway treatment in croup and epiglottitis. The increasing occurrence of laryngeal and tracheal complications with long-term intubation suggests that tracheostomy be considered in such cases.
Topics: Airway Obstruction; Croup; Epiglottis; Humans; Intubation, Intratracheal; Laryngitis; Time Factors; Tracheotomy
PubMed: 349884
DOI: No ID Found -
International Journal of Chronic... 2014Airway mucus is part of the lung's native immune function that traps particulates and microorganisms, enabling their clearance from the lung by ciliary transport and... (Review)
Review
Airway mucus is part of the lung's native immune function that traps particulates and microorganisms, enabling their clearance from the lung by ciliary transport and cough. Mucus hypersecretion and chronic productive cough are the features of the chronic bronchitis and chronic obstructive pulmonary disease (COPD). Overproduction and hypersecretion by goblet cells and the decreased elimination of mucus are the primary mechanisms responsible for excessive mucus in chronic bronchitis. Mucus accumulation in COPD patients affects several important outcomes such as lung function, health-related quality of life, COPD exacerbations, hospitalizations, and mortality. Nonpharmacologic options for the treatment of mucus accumulation in COPD are smoking cessation and physical measures used to promote mucus clearance. Pharmacologic therapies include expectorants, mucolytics, methylxanthines, beta-adrenergic receptor agonists, anticholinergics, glucocorticoids, phosphodiesterase-4 inhibitors, antioxidants, and antibiotics.
Topics: Anti-Bacterial Agents; Bronchitis, Chronic; Expectorants; Goblet Cells; Humans; Lung; Mucociliary Clearance; Mucus; Pulmonary Disease, Chronic Obstructive; Smoking Cessation; Treatment Outcome
PubMed: 24493923
DOI: 10.2147/COPD.S38938