Stenosing Laryngitis (Acute Stenosing Laryngotracheobrochitis, Croup Syndrome)

Stenosing Laryngitis (Acute Stenosing Laryngotracheobronchitis, Croup Syndrome)

An acute inflammatory process in the larynx, often involving the trachea and bronchi. It is observed, as a rule, in the initial period of ARVI as a manifestation of the disease itself, but it can also be the result of the addition of a bacterial factor, and then stenosing laryngitis is considered as a complication of ARVI. It occurs especially often in children with allergic and exudative-catarrhal diathesis and is more severe at an early age, often having an undulating course.

Inflammation and swelling of the mucous membrane with a relatively narrow lumen of the larynx in children cause difficulty breathing, aggravated by a reflex spasm.

Clinical picture:

Stenosing laryngitis often occurs acutely, mainly at night. In some children, it is preceded by symptoms of ordinary (non-stenotic) laryngitis (dry, especially barking cough, sore throat, slight hoarseness).

The severity of stenotic laryngitis is determined by the degree of stenosis and respiratory failure. There are four degrees of stenosis:

1. I degree stenosis - short-term difficulty breathing or longer, but mild; attacks of difficulty breathing occur rarely, noisy breathing, hoarse voice, barking cough, slight cyanosis, slight retraction of the pliable areas of the chest, mainly in the epigastrium. There is no respiratory failure.

2. Second degree stenosis is characterized by a duration (up to 5 days), a violation of the general condition of the child, who becomes restless, a barking, rough cough intensifies, and attacks of difficulty breathing often occur, accompanied by retraction of all pliable places of the chest; breathing is noisy, audible at a distance. The stenosis may be permanent or wavy in nature. Respiratory failure is moderate.

3. III degree stenosis is a significant and constant difficulty breathing with retraction of all pliable places of the chest (jugular fossa, supra- and subclavian spaces, epigastric region). Sweating, severe restlessness of the child are observed (the patient is tossing about in bed), breathing in the lungs is weakened. There are signs of cardiovascular failure and increasing hypoxemia - pallor, adynamia. Respiratory failure is severe.

4. IV degree stenosis - stage of asphyxia.

The diagnosis is made based on the history and clinical picture. Differential diagnosis is carried out with a foreign body of the respiratory tract, allergic laryngitis.

Treatment is carried out in a hospital and depends on the degree of stenosis, duration of the disease, the presence of toxicosis, age and condition of the child.

For treatment, the following are used: ensuring free access of air, distracting procedures, humidified oxygen, hypertonic solutions to reduce swelling, hormonal drugs, antibiotics, bronchodilators, cardiac and diuretics, sedatives and hyposensitizing drugs. If conservative therapy is ineffective, intubation or tracheostomy is used.

The prognosis for grades III-IV stenosis is serious; for grades I-II and timely treatment, it is favorable.

Prevention includes the prevention of acute respiratory viral infections, especially in children with allergic and exudative-catarrhal diathesis.