Laryngitis and epiglotittis in children
Martin Vavřina
Learning objectives2
Learning objectives
̶ Student will learn how to identify and distinguish both diagnoses.
̶ Student will learn basic differences between both diagnoses.
̶ Student will learn basic principles of the first aid in both disorders.
Laryngitis – what is it?3
Laryngitis
̶ full name: acute subglottic laryngitis
̶ typical diagnosis of the childhood
̶ typical seasonal incidence (october-march)
̶ typical daytime of onset (at night)
̶ most frequent between 2nd and 5th year of life (but also in
younger/older children)
̶ viral disease
Laryngitis – how does it look like?4
Laryngitis – how does it look like?
̶ etiology: parainfluenza/influenza virus, RS virus, rhinovirus,
coronavirus 
̶ frequent signs of mild respiratory infection (runny nose, common
cold) before the onset of symptoms
̶ onset is fast, often at night
̶ typical sign is hoarse, non-productive „barky“ cough, frequently
with wheezing inspiration (inspiratory stridor)
̶ child is able to swallow, usually is restless, crying
© Juliette Anderson, Youtube5
Laryngitis – how does it look like?
̶ https://youtu.be/Qbn1Zw5CTbA
̶ video shows typical „barking“ cough and inspiratory stridor
Laryngitis – signs/symptoms6
Laryngitis – signs/symptoms
̶ cough and dyspnea does not change with the position
̶ fewer is not typical, but lightly elevated temperature possible
̶ more severe forms show retraction of soft tissues on the neck and
chest
̶ with discomfort and crying the cough gets worse with more severe
dyspnea, global state of the patient can get much worse very
quickly, even if relatively OK on the beginning
Laryngitis – treatment7
Laryngitis - treatment
̶ examine the child as calm as possible, ideally in the arms of the
parent
̶ try your best to minimise invasive, uncomfortable and painful
procedures (e.g. intravenous access)
̶ first line treatment: cold air (open window, open refrigerator)
̶ other possibilities: corticosteroids, e.g. dexamethason (peroral or
rectal as suppository), usually available at home, when child has
repeated attacks
̶ prognosis: very good, but frequent relapse
Epiglotittis8
Epiglotittis
̶ full name: acute epiglotittis
̶ inflammation of the epiglottis
̶ most frequent in preschool and school age
̶ no seasonal incidence
̶ no typical daytime of onset
̶ relatively rare after implementation of mandatory vaccination
against Haemophilus influenzae in 2001 (beware of „anti-vaxers“)
̶ bacterial disease
Epiglotittis – how does it look like?9
Epiglotittis – how does it look like?
̶ etiology: Haemophilus influenzae type B
̶ acute, rapid bacterial inflammation of the epiglottis with massive
edema
̶ typical sign is severe throat pain and trouble swallowing – saliva
leaking from the mouth of the child
̶ child is abnormally calm, even lethargic, no crying and no cough
Epiglotittis – signs/symptoms10
Epiglotittis – signs/symptoms
̶ typical relief position: sitting and resting on hands
̶ typical high fewer more than 39 °C, commonly with shivers and
exhaustion
̶ global state of the child gets dramatically worse when lying down,
child usually starts to suffocate in this position
̶ never lay down the child on its back !!
Epiglotittis - treatment11
Epiglotittis - treatment
̶ if any suspicion, immediately transport the child to nearest hospital
̶ do not manipulate with the child, do not administer any medicine,
do your examination as minimal as possible
̶ it is essential to transport the child always in sitting position
(suffocation imminent)
̶ prognosis: serious, life threatening situation
Learning outcomes12
Learning outcomes
̶ Student knows the difference between the two diseases.
̶ Student is able to reliably distinguish both diseases in the terms of
the first aid.
̶ Student is able to provide the first aid for both diagnoses.
References13
References
̶ KLIEGMAN, Robert M., STANTON, Bonita F., ST. GEME III, Joseph
W., SCHOR, Nina F. a BEHRMAN, Richard E. Nelson Textbook of
Pediatrics. 1. 19th Edition. Philadelphia: Elsevier, 2011. ISBN
978-0-8089-2420-3.
̶ FUHRMAN, Bradley P. a ZIMMERMAN, Jerry J. Pediatric Critical
Care. 5th Edition. Philadelphia: Elsevier, 2017. ISBN 978-0-323-
37839-0.
Simulation Centre, Faculty of Medicine, Masaryk University
2020