1.Overview of acute simple laryngitis
Acute simple laryngitis refers to acute diffuse catarrhal inflammation of the laryngeal mucosa, mainly in the vocal fold area, and is one of the common acute infectious diseases of the adult respiratory tract, accounting for about 1% to 2% of otorhinolaryngological diseases. It can occur alone or secondary to acute rhinitis and pharyngitis, as part of an upper respiratory tract infection, or secondary to an acute infectious disease. The incidence is higher in males and occurs mostly in winter and spring.
Pediatric acute laryngitis is an acute inflammation of the laryngeal mucosa, mainly in the vocal fold area, often involving the mucosa and submucosa of the subglottis area, mostly in the winter and spring, with a peak in February, and is common in infants and young children. It has its own peculiarities compared with adults, especially easy to respiratory distress, because.
(1) The laryngeal cavity is small in children, and the mucous membrane in the larynx is loose and easy to cause obstruction of the voice box when there is swelling;
(2) The laryngeal cartilage is soft, and the mucosa and submucosa are loosely attached, so the swelling is heavier when inflammation occurs;
(3) The larynx is rich in submucosal lymphoid tissue and glandular tissue, which makes it easy to narrow the laryngeal cavity due to submucosal swelling;
(4) The cough reflex is poor in children, and secretions from the trachea and larynx are not easily discharged;
(5) The resistance to infection and immunity of pediatric patients are not as strong as those of adults, so the inflammatory response is more severe;
(6) The pediatric nervous system is more unstable, and laryngospasm can easily occur due to irritation;
(7) Laryngospasm can cause laryngeal obstruction, but also contribute to increased congestion, laryngeal cavity more narrow.
2, the etiology of acute simple laryngitis
(1) Infection is the main cause of the disease, mostly after the cold and flu, on the basis of viral infection secondary to bacterial infection. Commonly infected bacteria include Staphylococcus aureus, Streptococcus hemolyticus, S. pneumoniae, Cattamora, Bacillus influenzae, etc.
(2) Harmful gases Inhalation of harmful gases (such as chlorine, ammonia, sulfuric acid, nitric acid, sulfur dioxide, nitric oxide, etc.) and excessive productive dust can cause acute inflammation of the laryngeal mucosa.
(3) Occupational factors Such as teachers, actors and salesmen who use their voices more, the incidence is often higher when they use their voices improperly or excessively.
(4) Trauma to the larynx, such as foreign bodies or instruments that damage the mucous membrane of the larynx.
(5) Too much alcohol and tobacco, cold, fatigue, and lowered body resistance can easily trigger acute laryngitis. Sudden changes in air humidity and indoor dry heat are also triggers.
Pediatric acute laryngitis is often secondary to acute rhinitis and pharyngitis. Most of them are caused by viruses, the most easily isolated being the parainfluenza virus, which accounts for 2/3 of the cases, as well as adenovirus, influenza virus and measles virus. After the viral invasion, the conditions are provided for bacterial infection. The infecting bacteria are Staphylococcus aureus, Streptococcus b, S. pneumoniae, etc. Pediatric malnutrition, low resistance, allergic constitution, overlapping dental crowding, and chronic diseases of the upper respiratory tract, such as chronic tonsillitis, adenoid hypertrophy, chronic rhinitis, and sinusitis, are highly likely to induce laryngitis. Pediatric acute laryngitis can also be a precursor to acute infectious diseases such as influenza, pneumonia, measles, chicken pox, whooping cough, scarlet fever, etc.
(6) Some people believe that it is related to regional and racial factors.
3. Clinical manifestations of acute simple laryngitis
(1) Hoarseness is the main symptom of acute laryngitis, and most of them have a sudden onset.
(2) Laryngeal pain The patient has a slight pain in the larynx and front of the trachea, and feels discomfort, dryness, and foreign body sensation in the larynx.
(3) Increased laryngeal secretions There is often a cough, initially without sputum, and a sore throat when coughing, which increases at night. In the late stage, there is mucopurulent secretion, which is not easy to cough up and adheres to the surface of the vocal cords and aggravates hoarseness.
(4) Systemic symptoms Generally, the systemic symptoms are mild in adults and severe in children. In severe cases, there may be chills, fever, fatigue, loss of appetite and other symptoms.
(5) Inflammatory symptoms of the nose and pharynx.
(6) Examination The manifestation of the laryngeal mucosa varies with the development of inflammation at different times and is characterized by bilateral symmetry and diffuse nature. In the early stage, the surface of the vocal folds is light red with congested capillaries, gradually becoming dark red with rounded edges in the shape of a pike, and when the subglottic mucosa is obviously red and swollen, it is set off under the vocal folds and can be double vocal fold-like. Occasionally, small superficial ulcers are seen in the laryngeal mucosa.
Clinical features of pediatric acute laryngitis: the onset of the disease is more acute, with fever, hoarseness, and cough. In the early stage, laryngospasm is the main cause, and hoarseness is not serious, manifested as paroxysmal barking cough or dyspnea, followed by coughing up of mucous sputum, and persistent laryngeal obstruction may appear after repeated attacks, such as asthmatic cough and inspiratory stridor. The onset may also be sudden, with sudden nocturnal onset in children, frequent coughing, duller coughing, and growling. In severe cases, there is a four-concave sign on inspiration, and the face is cyanotic or irritable. Breathing becomes slower, about l0~l5 times/minute, and in late stage, shallow and fast breathing. If not treated in time, further development, cyanosis, sweating, pallor, respiratory weakness, and even respiratory and circulatory failure, coma, convulsions, and death may occur.
4.Diagnosis of acute simple laryngitis
Acute simple laryngitis can be initially diagnosed based on symptoms and examination, but should be differentiated from laryngeal tuberculosis, measles laryngitis, etc. Acute laryngitis in children can be initially diagnosed based on their medical history, season of onset and unique symptoms, such as hoarseness, laryngeal wheezing, barking cough sounds, and inspiratory dyspnea. Indirect laryngoscopy is feasible for larger children who can cooperate. If available, television fiberoptic laryngoscopy can be performed to observe the laryngeal mucosa and vocal cord activity in the awake, natural state. Oxygen saturation monitoring is also useful for diagnosis. It should be differentiated from tracheobronchial foreign body, pediatric laryngospasm, congenital laryngeal diseases, etc. In addition, attention should be paid to differentiate from the laryngeal manifestations of laryngeal diphtheria, measles, chicken pox, whooping cough, scarlet fever, and mumps.
5. Treatment of acute simple laryngitis
(1) Early use of broad-spectrum adequate antibiotics, congestion and swelling is significant with the addition of glucocorticoids. The key to the treatment of acute laryngitis in children is to lift the laryngeal obstruction, early use of effective, adequate antibiotics to control the infection. At the same time, glucocorticoids are given, commonly prednisone orally, 1~2mg/(kg?d); dexamethasone intramuscularly or intravenously 0.2~0.6mg/(kg?d).
(2) Administration of oxygen, antispasmodic, sputum, keep the respiratory tract unobstructed Oxygen can be administered by ultrasonic nebulized inhalation with water oxygen or through the nose. In the early stage of mucosal dryness, add peppermint, compound benzoin anhydride, etc. 0.04% Diquantinium chloride (Daphne Lalu) aerosol spray. If there is dry crust or pseudomembrane and mucous secretion under the vocal fold and dyspnea cannot be relieved by the above treatment, it can be aspirated or clamped out under direct laryngoscopy.
(3) Vocal fold rest No or little articulation.
(4) Nursing and systemic support therapy Adjust room temperature and humidity at any time, keep indoor air circulation, drink more hot water, pay attention to smooth bowel movement, avoid smoking and alcohol, etc.
(5) Strengthen monitoring and supportive therapy for critically ill children, pay attention to systemic nutrition and water-electrolyte balance, protect cardiopulmonary function, and avoid acute cardiac insufficiency.
(6) Rest quietly and reduce crying to lower oxygen consumption of the child.
(7) If severe laryngeal obstruction or laryngeal obstruction is not relieved after drug treatment, tracheotomy should be performed in time.
6. Prognosis of acute simple laryngitis
The prognosis of acute simple laryngitis is generally good and rarely causes laryngeal chondromyelitis, cartilage necrosis and laryngeal abscess. In acute laryngeal obstruction degree II, the breathing should be closely observed and prepared for tracheotomy, and in degree III, tracheotomy can be considered. Active treatment of acute laryngitis is the key to prevent it from becoming chronic. Breastfeeding for young children is an important protective measure. Prevent colds and flu, and treat acute laryngitis promptly if it occurs. The prognosis is generally good.