Subglottic laryngitis--Changes in therapy approach over the past 20 years

Area of Science:

• Pediatric Otolaryngology
• Respiratory Medicine
• Clinical Practice Guidelines

Background:

• Subglottic laryngitis management has seen shifts in therapeutic approaches over two decades.
• Understanding these changes is crucial for optimizing pediatric respiratory care.

Purpose of the Study:

• To analyze the evolution of subglottic laryngitis treatment strategies in Croatia from 1993 to 2013.
• To identify key changes in the management of moderately severe subglottic laryngitis.

Main Methods:

• A questionnaire-based survey was distributed to pediatricians and otolaryngologists in Croatian hospitals in 1993, 2003, and 2013.
• Respondents reported on their management of a standardized case of subglottic laryngitis and hospital practices.
• Trend analysis using the Cochran-Armitage test assessed changes in treatment over time (p<0.05).

Main Results:

• Racemic epinephrine use dramatically increased (pediatricians: 17.2% to 100%; ENTs: 3.3% to 92.3%).
• Humidification, antibiotic, and antihistamine use significantly declined.
• Corticosteroids (parenteral and nebulized) remained a consistent and central treatment modality.

Conclusions:

• Key changes in subglottic laryngitis management include increased racemic epinephrine use and decreased reliance on humidification, antibiotics, and antihistamines.
• Corticosteroids continue to be the cornerstone therapy for moderately severe cases.
• Therapeutic approach disparities between pediatricians and otolaryngologists have diminished over the 20-year period.