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Severe upper airway obstruction caused by ulcerative laryngitis
M Hatherill1, L Reynolds, Z Waggie
1Paediatric Intensive Care Unit, Institute of Child Health, Red Cross War Memorial Children's Hospital, Klipfontein Road, Cape Town, 7700, South Africa. hatheril@ich.uct.ac.za
Insights
Severe ulcerative laryngitis can cause upper airway obstruction in children. Early microlaryngoscopy is recommended for children with croup showing atypical symptoms, as this condition is more common than previously thought.
Area of Science:
- Pediatric Intensive Care
- Pediatric Otolaryngology
- Pediatric Infectious Diseases
Background:
- Severe upper airway obstruction in children often presents as croup.
- Ulcerative laryngitis is a rare but serious cause of airway compromise.
- The incidence and clinical course of ulcerative laryngitis in pediatric populations require further elucidation.
Purpose of the Study:
- To describe the experience with severe upper airway obstruction due to ulcerative laryngitis in children.
- To identify the incidence and clinical characteristics of ulcerative laryngitis in a pediatric intensive care unit (PICU) setting.
- To evaluate the diagnostic utility of microlaryngoscopy in suspected cases.
Main Methods:
- Retrospective case note review of 263 children with severe upper airway obstruction and croup diagnosis admitted to a PICU over five years.
- Microlaryngoscopy was performed on 148 children.
- Clinical data, including coexistent ulcerative gingivostomatitis and outcomes, were analyzed.
Main Results:
- Fifteen children (10%) were diagnosed with ulcerative laryngitis.
- Ulcerative laryngitis was more frequent in children with ulcerative gingivostomatitis (33%) compared to those without (5%).
- Nine children required nasotracheal intubation and five required tracheostomy; all 15 children survived.
Conclusions:
- Ulcerative laryngitis is a more prevalent cause of severe upper airway obstruction in this pediatric cohort than previously reported.
- Early diagnostic microlaryngoscopy is crucial for children with severe croup exhibiting atypical presentations.
- Prompt diagnosis and management can lead to favorable outcomes even in severe cases.
Aims:
To present our experience of severe upper airway obstruction caused by ulcerative laryngitis in children.
Methods:
Retrospective case note review of 263 children with severe upper airway obstruction and a clinical diagnosis of croup admitted to a paediatric intensive care unit (PICU) over a five year period.
Results:
A total of 148 children (56%) underwent microlaryngoscopy (Storz 3.0 rigid telescope). Laryngeal ulceration with oedema was documented in 15 of these children (10%), median age 14 months (range 10-36) and median weight 10 kg (range 6-12). Twenty seven of the children who underwent microlaryngoscopy (18%) also had ulcerative gingivostomatitis consistent with herpes simplex virus infection. Ulcerative laryngitis was documented in nine of 27 (33%) children with, and in six of 121 (5%) children without, coexistent ulcerative gingivostomatitis. One of the 15 children did not require airway intervention. Nine children required nasotracheal intubation for a median of 4 days (range 3-11) and median PICU stay of 6 days (range 4-14). Five children required tracheostomy ab initio, with a median PICU stay of 30 days (range 20-36), and duration of tracheostomy in situ for a median of 19 days (range 15-253). All 15 children survived.
Conclusion:
Ulcerative laryngitis is more common in our patient population than the few reports suggest. Early diagnostic microlaryngoscopy is recommended in children with severe croup who follow an atypical course.