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Acute laryngeal obstruction in children. A fifty-year review

F W Davison

    The Annals of Otology, Rhinology, and Laryngology
    |September 1, 1978
    PubMed

    Insights

    Acute laryngeal obstruction requires prompt diagnosis of causes like laryngotracheobronchitis and epiglottitis. Modern treatments including high humidity, antibiotics, and high-dose corticosteroids have drastically reduced mortality rates.

    Area of Science:

    • Pediatric Emergency Medicine
    • Otolaryngology
    • Critical Care

    Background:

    • Acute laryngeal obstruction is a critical condition in children.
    • Accurate differential diagnosis is essential for effective management.
    • Historical mortality rates for severe cases were as high as 70%.

    Purpose of the Study:

    • To review the differential diagnosis of acute laryngeal obstruction in children.
    • To trace the evolution of treatment strategies over the past 50 years.
    • To highlight key interventions that have improved patient outcomes.

    Main Methods:

    • Literature review of historical and current treatment approaches.
    • Analysis of diagnostic considerations for common causes.
    • Discussion of therapeutic modalities and their impact on mortality.

    Main Results:

    • Six primary causes of acute laryngeal obstruction are identified: acute laryngotracheobronchitis, acute epiglottitis, diphtheria, supraglottic allergic edema (angioedema), subglottic allergic edema (spasmodic croup), and foreign body.
    • Mortality rates have decreased from 70% to near zero due to advancements in care.
    • Effective measures include high humidity (ultrasonic nebulizer), antibiotics, and high-dose corticosteroids.

    Conclusions:

    • Prompt and accurate diagnosis is crucial for managing acute laryngeal obstruction.
    • Aggressive medical therapy has significantly improved survival rates.
    • Ongoing debate exists regarding the optimal airway management (tracheostomy vs. nasotracheal intubation) when medical therapy fails.

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