Full text of "Diseases Of The Nose Throat And Ear"
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ACUTE LARYNGOTRACHEAL INFECTIONS 159 stronger ones are required then one should reconsider the diagnosis and think of epiglottitis or perichondritis. ACUTE EPIGLOTTITIS This is seen in children more commonly than adults and while it may present as part of a generaTTVe^pperrespi>^or^trartinfr/'t1<r>r>, it may also occur on its own. DIAGNOSIS. The usual presentation is witjjjevep-attd severe pain deep in the throat especialjy_or^sw.allowing. If allowed to progress unchecked the inBan>~ matory oedema will track through the vast lymphatic spaces of the supraglottis— especially the ary-epiglottic folds—and will causemuffling of the voJce-and respiratory obstruction. Since these spaces are<~larger in children than in adults, it is a more dangerous disease in childhood. Examination with a mirror shows a bright red epiglottis, which will become very swollen as the disease progresses. The oedema will later be seen in the ary-epiglottic folds and arytenoids and examination will also become progressively more difficult since it becomes painful and difficult to protrude the tongue. TREATMENT. The commonest infecting organism is H. influenzae but whether it is an opportunistic invader secondary to a viral cause has not yet been shown. The antibiotic of choice is therefore ampicillin in larger doses than would be used in acute laryngitis because it is necessary for the drug to penetrate cartilage. All other efforts must be towards preventing supraglottic oedema and respiratory obstruction. In the early stages, inhalations and adrenaline hydrochloride (1 : 10 000) sprays may be sufficient, but if the oedema progresses the patient will have to receive at least lOOmg hydrocortisone intravenously every 4 hours. If respiratory obstruction continues the patient should have a tracheostomy oecause intubation may be difficult or impossible, and if the diagnosis is correct the bronchial tree should be relatively clear. The tracheostomy is only required for a few days provided that adequate therapy is maintained. ACUTE LARYNGOTRACHEOBRONCfflTIS This is a dangerous and common viral infection of the larynx, trachea and bronchial tree. It is almost confined to children and is seen more commonly in Australia and the Western side of the United States than elsewhere. DIAGNOSIS. The onset is relatively sudden and the child's temperature rises; he complains of a painful cough; the respiratory rate rises and signs of respiratory obstruction, such as indrawing of the suprasternal notch and venous engorgement, soon become obvious. There is increasing evidence of general toxicity. TREATMENT. The reason that respiratory obstruction is liable to occur early is that the subglottic region in the child is very lax and oedema occurs early in the upper trachea and subglottic space. If this were the only problem, then tracheostomy, if done in time, would prevent any deaths. This is not the case, however, because the inflammatory process extends downwards to involve the