Membranous laryngotracheobronchitis, a complication of measles

Membranous laryngotracheobronchitis is a very serious infection which affects the larynx, trachea and bronchi, requiring aggressive therapeutic measures. It has been recently rediscovered as a cause of disease in children. However, it is a very unusual complication of measles. Two infants with measles and membranous laryngotracheobronchitis are reported.

Tuberculous laryngitis--a one year harvest

We present nine patients with tuberculous laryngitis seen in our otolaryngology out-patient department during the year of 1983. Four patients were previously diagnosed as having pulmonary tuberculosis and were receiving or had received treatment for the complaint prior to our consultation. Of the nine patients, eight had positive chest X-rays for pulmonary tuberculosis. Three patients were known to have positive sputum results; in three patients the result was not known, whilst in the remaining three patients the result was recorded as negative. Biopsies done on four patients were compatible with the diagnosis of tuberculous laryngitis. Two of these four were undisputedly confirmed by the presence of Acid-fast Bacilli on histological sections. Two patients demonstrated permanent structural derangement of the larynx as end-result manifestations. The incidence, site and appearance of the lesions, diagnosis and treatment are discussed.

Recurrent croup

Thirty one of 486 children followed from birth had recurrent croup in the first four years of life. Twenty one were boys, and 10 girls. Recurrent croup occurred significantly more often in families with a positive history of allergy but was not significantly associated with the initial feeding method.

[Special infections of the respiratory tract in children]

Inspiratory or exspiratory stridor associated with dyspnea represents a common pediatric symptomatology compatible with various diseases which usually are of infectious etiology. The causative obstruction of the infantile airways may lead to life-threatening respiratory failure. A review is conducted of the most important emergencies characterized by stridor and dyspnea in early childhood: croup syndromes (acute viral laryngotracheitis, spasmodic croup, bacterial tracheitis), epiglottitis and bronchiolitis.

[Air pollution and bronchopulmonary disease in children]

In recent years air pollution was linked to the croup-syndrome and sudden infant death syndrome (SIDS). There is no doubt, that the incidence of bronchopulmonary disorders in infancy and childhood is higher than usual in more polluted areas. That has been proven especially for recurrent bronchitis and asthma syndrome. It may be possible, that there ist a higher frequency of pseudo-croup in extremely polluted areas. However, there is no certain link between air pollution and SIDS. Indoor pollution, or pollution of the micro-environment, is as important as outdoor pollution regarding bronchopulmonary diseases in infants and children. Smoking parents are the most important contribution to indoor pollution. Pediatricians should not only discuss airborn pollution but equally the importance of indoor environmental pollution as having a negative influence on the respiratory system as well.

Postintubation croup in two consecutive patients undergoing cleft lip and/or palate repair

Postintubation croup is not common, but it is potentially serious complication of surgery and anesthesia. We report 2 consecutive cases of postintubation croup in infants undergoing cleft lip and/or palate repair, each occurring after an uncomplicated postoperative course of 48 hours' duration.

Acid posterior laryngitis. Aetiology, histology, diagnosis and treatment

The authors have treated 44 patients with posterior chronic acid laryngitis. Biopsy was performed in all patients. Characteristic changes typical of the hyper-regenerative or atrophic phase of reflux oesophagitis were identified in all specimens. Gastric hypersecretion was proven in all but two patients. The aetiologic factors of acid posterior laryngitis are gastro-oesophageal reflux, with friction of both vocal processes during phonation and vocal abuse. The preferred therapy is removal of circumscribed lesions with a suitable medical regimen.

Acute Hemophilus parainfluenzae epiglottitis in an adult

A 60-year-old man, who had non-insulin-dependent diabetes but was otherwise in good health, was hospitalized for sudden upper airway obstruction and respiratory arrest. Findings on fiberoptic laryngoscopy were consistent with acute epiglottitis. Blood cultures and factor analysis later revealed that the responsible pathogen was Hemophilus parainfluenzae. Acute epiglottitis in the adult is no longer considered rare and is usually attributed to H influenzae. The case described here and two other cases reported elsewhere indicate that H parainfluenzae may also be a cause of this serious and often fatal infection of the upper respiratory tract.

Epiglottitis due to ampicillin-tolerant Haemophilus influenzae type b

Tolerance to beta-lactam antibiotics has been described with staphylococci and enterococci, but this phenomenon and its clinical significance in Haemophilus influenzae has not been reported. We have reported a case of bacteremic epiglottitis due to an ampicillin-tolerant, beta-lactamase-negative strain of Haemophilus influenzae type b which was cured with ampicillin therapy alone. The organism was not tolerant to moxalactam, cefotaxime, or rifampin. Rifampin therapy eliminated pharyngeal carriage.

A prospective study of laryngotracheal sequelae in long-term intubation

A series of 200 patients having endotracheal intubation between 2 and 24 days were studied prospectively. The data was organized into 3 groups as follows: Group I: 2 to 5 days intubation, (50); Group II: 6 to 10 days intubation, (100); and Group III: 11 to 24 days intubation, (50). For the Group I population, the most significant injury is in the posterior commissure of the larynx which in this site leads to acute and chronic sequelae. At these intubation times, cuff site injury has not been prominent. Despite the selection of patients for conversion to tracheotomy in order to prevent complications, there is an increased incidence of significant sequelae in Group II population. A most noticeable trend accompanying the increased incidence is the changing nature of the resultant stenosis to include continuous damage from the posterior glottis through the cervical trachea. These trends become evident in those patients having intubation times greater that 7 days. In Group III population, the increased incidence, as well as the severity of post-intubation complications become clearly evident. Conversion to tracheotomy before serious organ disruption occurs at these prolonged intubation times is preventative.

[Membranous laryngotracheobronchitis]

Four cases of membranous laryngotracheobronchitis (MLTB) are presented. This entity is defined as an inflammation of larynx, trachea and bronchi, with mucopurulent membranes adhered to subglottic space wall. Radiological study shows irregularity of the proximal tracheal mucosa as well as adhered membranes resembling foreign bodies. Two out of the four children suffered from measles and one had staphylococcal pleuropneumonia. Tracheal aspirate obtained by laryngoscopy yielded S. aureus in two cases, and beta-lactamase positive H. influenzae in another. All patients required nasotracheal intubation and antibiotherapy. Characteristics of MLTB are discussed, pointing out its difference from viral laryngotracheobronchitis. Possibility of MLTB being initially a viral process undergoing bacterial superinfection later on is analyzed.

Acute epiglottitis in adults

We treated four adults whose upper airway was compromised due to acute epiglottitis. We also reviewed the English literature for all reports of this condition in adults (18 years and older). Among the 158 cases, the infectious etiology was identified in 29 (H. influenzae 20, Streptococcus pneumoniae six, H. parainfluenzae two, Streptococcus pyogenes one). In the remaining cases, the etiology was uncertain. Bacteremia was documented in 23/32 patients (71.9%), but extra-epiglottic infections were strikingly rare (X = six). The clinical manifestations were sore throat (100%), fever (88%), dyspnea (78%), dysphagia (76%), anterior neck cellulitis or tenderness (27%), hoarseness (21%), pharyngitis (20%) and anterior cervical lymphadenopathy (9%). Complete airway obstruction ensued in 23 out of the 119 subjects (18.3%) who had respiratory difficulty. Overall mortality rate was 17.6% but it was 6.4% among the patients who were semi-electively tracheostomized or endotracheally intubated. These findings illustrate that antibiotics therapy active against H. influenzae is required in the treatment of acute epiglottitis in adults. Additionally, airway patency should be established when inspiratory stridor appears assuring uncomplicated recovery.

Clinical evaluation of functional dysphonia

Functional dysphonia is a voice impairment without any organic lesion of the phonating system. It may be classified into two categories: functional dysphonia itself where no lesions are found and functional laryngopathies where vocal cord lesions may be attributed to vocal abuse or misuse. The clinical evaluation of a dysphonic patient is performed in three steps: history taking, vocal evaluation, and examination. History taking helps the diagnosis and may be considered also as a therapeutic procedure. Vocal evaluation is oriented toward the voice itself and how it is produced. Then an ENT examination is performed with special attention to the larynx. In functional dysphonia, usually, everything looks normal but there may be signs of inflammation, hyperkinetism, hypokinetism, excessive laryngeal movements, etc. Functional laryngopathies include vocal nodules, laryngitis, polyps, and contact ulcer.