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Laryngitis in children - what do symptoms look like?

 Laryngitis in children - what do symptoms look like?

Laryngitis in children - what do symptoms look like?


Laryngitis is a medical term that refers to inflammation of the larynx, that is, larynx, and (like other inflammations) can be acute and chronic. Acute laryngitis is more common in childhood, but despite this diagnosis being made very rarely, it is rarely an isolated inflammation of the larynx.

Laryngitis in children - what do symptoms look like?

Epidemiology and common causes

Symptoms of acute laryngitis

Spastic subglottic and bacterial laryngotracheobronchitis

A therapeutic approach to acute laryngitis

Medicamentous treatment

Differential diagnostics and additional processing

Epidemiology and common causes

The most common causes of acute respiratory infections, including laryngitis in children, are viruses.

Acute laryngitis usually occurs as part of an acute respiratory infection whereby inflammation affects the entire mucous membrane of the upper respiratory tract, that is, the mucous membranes of the nose, throat, and larynx. If inflammation also affects the mucous membranes of the trachea and bronchi, or lower respiratory tract, we are talking about acute laryngotracheitis or laryngotracheobronchitis.

 

Viruses are the most common cause of acute respiratory infections. The clinical picture of acute laryngitis is primarily caused by type I, II and III parainfluenza viruses, but also by all other respiratory viruses, such as influenza viruses, adenoviruses, respiratory syncytial virus (RSV) and human metapneumovirus. Acute respiratory infections (including acute laryngitis) are more common during the colder times of the year, that is, in the fall and winter.

 

On the other hand, bacterial laryngotracheobronchitis is a much more serious disease than these viral laryngotracheitis, but nowadays, primary bacterial laryngeal infections are much less common after children are systematically vaccinated against diphtheria and Haemophilus influenzae . If a bacterial infection occurs, it is mostly a superinfection, that is, the development of a bacterial infection in a previously damaged airway mucosa.

 

Symptoms of acute laryngitis

Acute laryngitis often recurs, and so infants often have recurrent inflammation during the viral infection season.

The initial symptoms of acute laryngitis resemble those of a cold. Thus, mild to moderate fever, nasal secretion, sore throat occurs, and then (within a few hours) symptoms of hoarseness and hoarse cough develops, similar to dog barking, which are characteristic of laryngeal inflammation. Acute laryngitis often recurs, and so infants often have recurrent acute laryngitis during viral respiratory infections. The attacks usually cease in preschool.

 

In fewer children, the symptoms are more pronounced. The cough is intense, the children are very hoarse, and breathing can be audible and difficult. Deterioration generally occurs abruptly and occurs in the late hours of the night or early morning. The baby wakes from sleep or wakes up with the child's audible and labored breathing, so acute laryngitis is a common reason for visiting an emergency pediatric service at night. The child has a feeling of lack of air, and as a result, a sense of fear develops, which then contributes to an even faster and heavier breathing and marked anxiety of the child.

 

Spastic subglottic and bacterial laryngotracheobronchitis

Although acute laryngitis is most often triggered by acute viral infection and accompanied by symptoms of upper respiratory tract infection, in some children laryngitis occurs independently of acute infections. These children can also have seizures during the summer months. In general, the symptoms are almost the same as those already mentioned, but they occur without the accompanying febrility and signs of upper respiratory tract infection. Parents usually state that the child has gone to bed healthy and has woken up suddenly with a hoarse cough and shortness of breath. This type of laryngitis is also called spastic subglottic laryngitis, and the tendency can be genetically predisposed so more members of the family may have the same problems.

 

Furthermore, the clinical picture of bacterial laryngotracheobronchitis is much more difficult when compared to viral laryngitis. The baby is generally of poor general condition, highly febrile, hoarsely coughing and short of breath. The mucous membrane of the airway builds up a tough, thick, purulent secretion that closes the lumen of the airways, making it difficult to breathe. A child with bacterial laryngotracheitis gives the impression of a seriously ill child who needs antibiotic treatment, and often requires intubation to maintain the airway.

 

A therapeutic approach to acute laryngitis

In most cases of acute laryngitis, it is sufficient for the child to rest, drink plenty of fluids and use antipyretics as needed.

In many children, the symptoms of acute laryngitis are mild and do not require special treatment. It is enough for the child to be still, drink plenty of fluids and, if necessary, use antipyretics, medicines for lowering body temperature. However, as some children may be more likely to have clinical problems, it is not unusual that parents who first experience acute laryngitis usually panic in an ambulance because they think their child is suffocating.

 

In addition, attacks of acute laryngitis are often associated with allergy, although there is no clear evidence for this, and treatment with antihistamines (medicines used to treat allergic diseases) is not recommended. The treatment is the same as in laryngitis triggered by an acute viral infection.

 

Objectively, a child is very, very seriously at risk of life. Oxygen saturations, which are measured when children with acute laryngitis come to the emergency room, are generally within the normal range, therefore, airway relief interventions (such as intubation) are rarely needed. However, this group of children needs medication.

 

Medicamentous treatment

Inhalation corticosteroid budesonide has recently been increasingly used in the treatment of acute laryngitis.

There are two groups of drugs that are most commonly prescribed in acute laryngitis. In the first group, inhaled adrenaline. It is a short-term inhalation whose active substance, adrenaline, leads to a decrease in laryngeal mucosal swelling, thus alleviating the symptoms of the disease. The adrenaline rush is fast but short-lived. According to the doctor's assessment, it can be repeated after twenty minutes or after several hours.

 

The second group of drugs are corticosteroids, which are proven to be effective in treating acute laryngitis, although their action is much slower. Corticosteroids can be administered orally, but this is usually impossible in smaller children, so they are more commonly administered as intramuscular or intravenous injections. Inhalation corticosteroid budesonide has recently been increasingly used in the treatment of acute laryngitis. Usually a single drug is sufficient, but sometimes treatment over several days is required.

 

A child with acute laryngitis usually does not require hospital treatment. Most often, the child is observed for several hours in an ambulance after administration of the drug. If a regression of symptoms occurs, the child may be discharged to home care.

 

Differential diagnostics and additional processing

Recurrent laryngitis requires caution and additional treatment to rule out any other etiology of the disease.

If the symptoms of laryngitis do not improve with the above therapy, other conditions leading to hoarseness and cough should be considered. Young children should primarily suspect a foreign body in the upper respiratory tract. Also, allergic reactions to food, inhaled allergens or insect bites can be presented by swelling of the laryngeal mucosa which then mimics the clinical picture of acute laryngitis.

 

Recurrent laryngitis also requires caution and additional treatment. Although the most common is recurrence of spastic subglottic laryngitis in an otherwise healthy child, it is necessary to rule out another etiology: especially congenital laryngeal malformations, cysts, malformations of blood vessels, tumor mass, gastroesophageal or laryngopharyngeal reflux.

 

If processing does not reveal the cause of laryngitis relapses requiring specific therapy, parents should be informed of the nature of the disease and the possible complications. This group of children may be prescribed an inhaled corticosteroid (budesonide), which can be administered at home at the first signs of the disease to help ease its course.


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