Subglottic laryngitis (laryngitis subglottica, pseudocroup) occurs frequently during a viral respiratory epidemic, it starts suddenly and it is more common in younger children than in older. In adults, it occurs very rarely.
A large number of cases of pseudocroup fits into that typical picture, but there are other, less regular, in whom severe laryngeal stridor and cyanosis require the patient to be confounded in the otorhinolaryngological department of a hospital so that at any given moment a tracheotomy could be performed.
Subglottic laryngitis symptoms
The disease usually starts at night. Breathing difficulties start from a light catarrhal state of upper and lower respiratory tract, and the condition worsens during the night. A considerable degree of face cyanosis can occur. Body Temperature is slightly elevated, and the general condition is not heavily disturbed. A cough that resembles the barking dog occurs along with stridor breathing, but the voice is clear and resonant. Just before morning, breathing improves and during the day it may be fine. The next night heavy breathing and the characteristic cough recur, but the degree of laryngeal stridor is not as significant as it was the previous night. During the next day all the symptoms gradually disappear.
The diagnosis of subglottic laryngitis
The diagnosis of Subglottic laryngitis can usually be easily set during direct laryngoscopy. With pseudocroup pale mucous protrusions in the form of smooth oedematous cushion can be seen below the vocal cords in subglottic space one on each side of vocal cords. These protrusions significantly narrow down the airway. There aren’t any secretions or pseudomembrane. The vocal folds are smooth and pale, as well as other parts of the larynx. Phonatory and respiratory movement of the vocal cords is good. Nevertheless, one should, as a precaution, take swabs from the mucosa surface to the bacteriological examination.
Subglottic laryngitis treatment
If subglottic laryngitis leads to the need that the child should be admitted to a otorhinolaryngological department, due to heavy breathing, a similar treatment as for acute laryngotracheobronchitis is to be applied. Tracheotomy should be postponed as long as possible, given that the conservative treatment is mostly successful, the condition improves as the morning approaches and that the disease is not accompanied by toxic influence of an infection, as with acute laryngotracheobronchitis or diphtheria. After treating the acute condition it is necessary to do an allergy treatment.
After general viral and bacterial infections severe forms of inflammation of the larynx can occur. It may occur in a form of diffuse purulent inflammation of mucosa of the entire larynx (laryngitis purulenta), and even in forms of laryngitis, that are characterized by creating a pseudomembrane (laryngitis pseudomembranacea). They occur during measles and scarlet fever and if this is the case a tracheotomy may be required. Each case of this type should be taken into a consideration when setting up a differential diagnosis of diphtheria.