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Viral Laryngotracheitis (Croup)

Acute laryngotracheitis (viral croup) is the most common infectious cause of acute upper airway obstruction in pediatrics, causing 90% of cases. The disease is usually benign and self-limited. Children in the 1-2-year-old age group are most commonly affected, and the male-to-female ratio is 2:1. Viral croup affects 3-5% of all children each year. Croup is most common from the late fall to early spring, although cases may occur throughout the year.

Clinical Evaluation of Upper Airway Obstruction and Stridor

Stridor is the most common presenting feature of all causes of acute upper airway obstruction. It is a harsh sound that results from air movement through a partially obstructed upper airway.

Supraglottic disorders, such as epiglottitis, cause quiet, wet stridor, a muffled voice, dysphagia and a preference for sitting upright.

Subglottic lesions, such as croup, cause loud stridor accompanied by a hoarse voice and barky cough.

Patient Age

Upper airway obstruction in school age and older children tends to be caused by severe tonsillitis or peritonsillar abscesses. From infancy to 2 years of age, viral croup and retropharyngeal abscess are the most common causes. Between three to six years of age, epiglottitis peaks.

Mode of Onset

Gradual onset of symptoms, usually preceded by upper respiratory infection symptoms, suggests viral croup coup. Severe tonsillitis or retropharyngeal abscess.

Very acute onset of symptoms suggests epiglottitis. A history of a choking episode or intermittent respiratory distress may represent a foreign body inhalation. Facial edema and urticaria suggests angioedema.

Emergency Treatment of Upper Airway Obstruction

Maintaining an adequate airway takes precedence over other diagnostic interventions laryngitis. If a supraglottic disorder is suspected, a person skilled at intubation must accompany the child at all times. Patients with suspected epiglottitis, severe respiratory distress from an obstruction, or suspected foreign body croup, inhalation should be taken to the operating room for direct visualization and possible croup intubation. Those patients who are not suspected of having epiglottitis, but who have only mild or moderate respiratory distress.