New Infections of Larynx
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Transcript of New Infections of Larynx
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Infections of larynx
Drravikumar M.S(ENT)
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laryngitis
Acute laryngitis
Acute epiglottitis
Acutelaryngotracheobronchi
tis
Diphtheric laryngitis
Chronic laryngitis
tuberculosis
Scleroma Syphilis
leucoplakia
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Acute laryngitis Aetiology
Age
Infection or other URTI
Vocal misuse
Seasonal
Irritation
iatrogenic
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symptoms Hoarseness
Rawness
Pain
Cough
Stridor
Constitutional symptoms
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signs Congestion of vocal cords
Oedema
Exudate
White plaques-influenza
Movements of vocal cords
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Treatment Voice rest
Steam inhalation
Antibiotics
Anti-inflammatory drugs
Steriods
Endotracheal intubation
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Aetiology-
Age-2-7 years
Common organism-H.influenza B
Acute epiglottitis
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ACUTEEPIGLOTTITIS Classic symptoms-
abrupt onset ofhigh fever
sore throat, stridor, dysphagia, and
drooling, Usually no cough
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Acute epiglottitis P.E.- toxic-appearing, apprehensive, often
sits in tripod or sniffing position, voice
may be muffled, marked tenderness withpalpation ofhyoid
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investigations Blood exam-WBC RAISED
Predominance of polymorphonuclear leuco
Blood cultures
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investigations XRays- epiglottis is swollen thumbprint at
the base of the hypopharynx
Commonly vallecular space obscured Supraglottic ballooning
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X-ray
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EPIGLOTTITIS Airway Management- Try not to disturb
the patient!
Oxygen as needed Nebulized racemic epinephrine- decreases
airway edema
-for difficult airway mgt or respiratory failure
requires intubation &tracheostomy
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EPIGLOTTITIS Rx Management
2nd or 3rd cephalosporin +/- vancomycin
Oral ATBX for 7-10 days after extubation
Steroids remain controversial
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Viral Croup
(laryngotracheobronchitis) Most common cause of stridor after
neonatal period
Most affected are children 6 mo.- 3 y.o Peak incidence b/t 1-2 yrs of age
Narrowest part of airway is at cricoid cartilage
and inch
ildren 1 mm of airway edema may cross-sectional area 50-60%
Most cases occur late fall or early winter
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VIRAL CROUP Etiology-mostly viral
Parainfluenza virus type I,II,
Incubation 2-6 days, virus shed for about 2 weeks
Mycoplasma pneumoniae may present with
croup like syndrome
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VIRAL CROUP Signs & Symptoms
1-5 day prodrome ofcough, coryza, +/- low
grade fever and URI type symptoms Followed by 3-4 days of barking cough, worse
in late evening and night
+/- biphasic stridor: inspiratory component
greater than expiratory. Unaffected by position,worsened by agitation orcrying
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VIRAL CROUP Diagnosis- made clinically
X-rays: If othercauses being considered orin atypical or prolonged cases
Obtain lateral neck films and PA CXR
PA CXR in croup steeple sign
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Treatment
Continued
Racemic Epinephrine
Acts by vasoconstriction of mucosal vessels
0.5ml of 2.25%sol diluted in 3ml of saline
Recommended to watch patient for 3 hrs
before considering discharge
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Treatment
Continued
Dexamethasone
Steroids-used with moderate to severe episodes
ofcroup
Mild episodes controversial to tx with steroids
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VIRA
LC
ROUP-T
reatment Pulse ox, and humidified O2
Often improvement afterchild has been in cold night air ormoist air from shower
Antipyretics if fever present
Antibiotics not indicated IV fluid hydration only if necessary
Nebulized Albuterol
Stridor only with agitation- doesnt need epinephrine
Stridor at rest orchild in respiratory distress-tx with
epinephrine and steroids Intubation if respiratory failure or pending (use ETT 0.5 to
1.0 mm smaller than typically used)
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SPA
SM
ODIC
C
ROUP
Thought to be on continuum with acute
viral croup
Seen more commonly in atopicchildren No seasonal variation
Usually resolves within 6 hours of onset
Often recurrent and not associated withfever
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Epiglottitis Croup
Age Can occur in infants, olderchildren, or adults
Six months to six years
Onset Sudden Gradual
Location Supraglottic Subglottic
Temp High fever Low-grade fever
Dysphagia Severe Mild or absent
Dyspnea Present Present
Drooling Present Present
Cough Uncommon Chracteristiccough
Position Sitting forward with mouth open Comfortable in different
positionsRadiology Positive thumb sign* Positive steeple sign
.
Comparison of the Features of Epiglottitis and Croup
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Laryngeal diphtheria Aetiology-secondary to faucial diphtheria
Age-below 10yrs
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Larynge
al diphtheri
a
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Pathogenesis and pathology
The organism produces a toxin that inhibits
cellular protein synthesis and is responsible
for local tissue destruction and
pseudomembrane formation.
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Clinical manifestations The incubation period of diphtheria is 2-4 days
(range, 1-7 days).
This disease can involve almost any mucous
membrane.
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Laryngeal diphtheria Laryngeal diphtheria can be either an
extension of the pharyngeal form (often) or
the only site involved (rarely).
Symptoms include mild fever (with little
absorption of toxin), dyspnea, hoarseness,
and a barking cough.
The pseudomembrane can lead to airway
obstruction, coma, and death.
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Clinical manifestations The major sign is pseudomembrane. The
typical pseudomembrane is adherent to the
tissue, and forcible attempts to remove it
cause bleeding.
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Laboratory findings Routine examination
Leukocytosis, 10~20 G/L, neutrophil is
dominant. Low platelet count (thrombocytopenia), rise
profiles of the serum enzyme tests and
proteinuria were found in serious cases.
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Laboratory findings
Bacteriological examinations
Smear and gram stain can found C.
diphtheriae, but can not identify from thediphtheroids.
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Laboratory findings
Bacteriological examinations
C. diphtheriae can be cultured from the
swabs from nose, pharynx or other sites.
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Laboratory findings
Immunological examinations
Schick test (not to be used any more),
positive result supports diagnosis Specific antibody detection. Positive results
deny the diagnosis since it is a protective
antibody.
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Diagnosis
Gram stain of material from the
pseudomembrane can be helpful when trying
to confirm the clinical diagnosis.
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Diagnosis
Culture of the lesion is even important to
confirm the clinical diagnosis. It is critical to
take a swab of the pharyngeal area, especially
any discolored areas, ulcerations, and
tonsillar crypts.
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Treatments
General measures
Relax on bed for more than 3 weeks, 4-6
weeks for patients with myocarditis.
Provide adequate energy and nutriments
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Treatments Diphtheriaantitoxin
Diphtheria antitoxin, produced in horses.
It will not neutralize toxin that is already
fixed to tissues, but will neutralizecirculating toxin.
Early use will prevent progression of
disease.
The earlier, the better.
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Treatments
Diphtheriaantitoxin
Dose: 3-5104 U for early (3-4d)
or grave patients; reduce in larynx diphtheria
1-2104 U is given intravenously and the restis given intramuscularly.
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Treatments Diphtheriaantitoxin
The patient must be tested for sensitivity
before antitoxin is given.
Respiratory support and airwaymaintenance should also be administered
as needed. (Pseudomembrane shedding
often happens during disintoxication)
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Treatments
Antibiotics
Prevention of further toxin production.
Control local infection.
Reduction of transmission.
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Treatments
Antibiotics
Procaine penicillin G daily, intramuscularly
(300,000 U/day for those weighing 10 kg or
less and 600,000 U/day for those weighing
more than 10 kg) for 7-10 days.
Erythromycin orally or by injection (40-50
mg/kg/day; maximum, 2 gm/day) for 14 days.
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treatment Pt allergic to pencillin G or erythromycin
can use rifampin orclindamycin
The disease is usually not contagious
48 hours after antibiotics are used.
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Complications Myocarditis
Present as abnormal cardiac rhythms and
can occur early in the course of the illness orweeks later, and can lead to heart failure and
abrupt deterioration (sudden death).
If myocarditis occurs early, it is often fatal.
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Complications Neuritis
Most neuritis often affect motor nerves and
usually recovers completely. Paralysis of the soft palate is most frequent
during the third week of illness.
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Complications Neuritis
Eye muscles, limbs, and diaphragm paralysis
can occur after the fifth week. Secondary pneumonia and respiratory failure
may result from diaphragmatic paralysis.
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Complications Other complications
Include otitis media and respiratory
insufficiency due to airway obstruction,especially in infants.
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Preventions
Management of infection sources
For close contacts, especially household
contacts, a diphtheria booster, appropriate
for age, should be given. Antitoxin 1000-2000
U, intramuscularly
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Preventions
Management of infection sources
Contacts should also receive antibiotics
benzathine penicillin G or a 7- to 10-day
course of oral erythromycin.
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Tuberculosis of larynx
Aetilogy-secondary to pulmonary TB
Pathology-
c/f-symptoms
Hoarseness
Dysphagia
Referred pain
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Laryngeal exam Hyperaemia of vocal cords
Swelling in interarytenoid
Ulceration of VC-mouse nibbed app
Pseudoedema of epiglottis-turban epiglottis
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diagnosis Blood exam
Chest x-ray
Sputum exam
Biopsy
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treatment ATT THERPHY-
Voice rest
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THEEN
D