INFECTIONS OF THE LARYNX AND EPIGLOTTIS
- Laryngitis: Acute laryngitis is a common syndrome caused by nearly all the major respiratory viruses and by some bacteria (e.g., GAS, C. diphtheriae, and M. catarrhalis). Chronic cases of infectious laryngitis are much less common in developed countries than in low-income countries and are caused by Mycobacterium tuberculosis, endemic fungi (e.g., Histoplasma, Blastomyces, Coccidioides), and Cryptococcus.
- Pts are hoarse, exhibit reduced vocal pitch or aphonia, and have coryzal symptoms.
- Treatment of acute laryngitis consists of humidification, voice rest, and—if GAS is cultured—antibiotic administration. Treatment of chronic laryngitis depends on the pathogen, whose identification usually requires biopsy with culture.
- Epiglottitis: acute, rapidly progressive cellulitis of the epiglottis and adjacent structures that can result in complete—and sometimes fatal—airway obstruction
- Epiglottitis is caused by GAS, S. pneumoniae, Haemophilus parainfluenzae, and S. aureus; pediatric cases due to H. influenzae type b are now rare because of vaccination.
- Symptoms include fever, severe sore throat, and systemic toxicity, and pts often drool while sitting forward. Examination may reveal respiratory distress, inspiratory stridor, and chest wall retractions.
- Direct visualization in the examination room (i.e., with a tongue blade) should not be performed, given the risk of complete airway obstruction. Direct fiberoptic laryngoscopy in a controlled environment (e.g., an operating room) may be performed for diagnosis, procurement of specimens for culture, and placement of an endotracheal tube.
- Treatment focuses on airway protection. After blood and epiglottis samples are obtained for cultures, IV antibiotics active against H. influenzae (e.g., ampicillin/sulbactam or a second- or third-generation cephalosporin) should be given for 7–10 days.
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