Laryngitis: What are the symptoms of laryngitis? Is it a risk to children?

Laryngitis, or laryngitis, is the most common inflammatory disease of the airways. It affects every age category.

In young children, due to the anatomical peculiarity of the airways, it may progress more seriously. The swelling reduces the already small breathing space and complicates the passage of air into the lungs.

The course is acute or chronic. Infectious or non-infectious cause.

You are most often interested in information: What is laryngitis, why does it occur and how does it manifest itself? Why is it a risk especially for small children? How is it transmitted? How is it different from epiglottitis?

Information about the larynx in brief

The larynx, or larynx, belongs to the human respiratory system. Passes him the air from the mouth and nose into the trachea and then the lungs.

In addition to the passage of air into the lower airways, it also has a voice-forming function - phonation. Participates with the pharynx and when swallowed.

Its placement is in front of the pharynx. Its walls are reinforced with cartilage, formed by their muscles and internal mucosa.

Cartilage is known especially laryngeal príchlopa - epiglottis, mighty men thyroid cartilage -  cartilage thyroid or annular cartilage - cartilage Crinoidea, and the creation of important voice arytenoid cartilage  - cartilage arytenoid.

The vocal cords, technically the glottis, are the basic vocal instrument.

In the formation of the voice,  phonation, several structures of the larynx are involved, and thus ligaments, muscles, cartilage. The air passes through the vocal fold, vibrating the vocal folds - plicae vocales. Their quick closing and opening create sound.

The vibration cycle, while making sounds, approaches 200-400 repetitions in one second.

Resonant cavities are also important for voice color:

• larynx
• pharynx
• nasal cavity
• oral cavity
• beneficial cavities

The difference between the male and female voice is created by the length of the vocal cords. They are 24-25 millimeters in length for men and about 20 millimeters for women. A deeper male voice also causes a more spacious larynx.

The overall character of the voice is further provided by a soft or hard climate, tongue, teeth, lips and even cheeks.

Pathological changes, in any part, are manifested by a change or disturbance of the voice.

Back to laryngitis

Thus, laryngitis is an inflamed larynx. It is formed on an infectious or non-infectious basis. It can affect several parts of it.

It takes place in acute or chronic form.

We know, for example, acute epiglottitis, which is a life-threatening condition in children, acute catarrhal laryngitis, or acute subglottic laryngitis. An example of chronic is an atrophic or hypertrophic form of laryngitis. Among the specific inflammation is one of tuberculosis, but also syphilis of the larynx.

See also: Epiglottitis.

Brief information on the forms of laryngitis in the table

Acute subglottic laryngitis

Acute upper respiratory tract disease of viral origin.

The most common viruses are:

• parainfluenza - Myxovirus parainfluenzae type 1, 2 or 3
  • represent 30-50% of cases
• influenza virus A, B - influenza viruses
• adenovirus
• coronavirus
• RSV
• rhinovirus - even with rhinitis
• human metapneumovirus
• summer forms - Mycoplasma pneumoniae, enteroviruses (coxackies, echoviruses)

It is accompanied by swelling of the subglottic area - the place under the laryngeal flap. Inflammatory swelling reduces lumen, ie the inner space of the larynx for the passage of air into the lower respiratory tract and lungs. This causes suffocation and wheezing when inhaled or a characteristic barking cough.

It occurs mainly in children, on average from the 6th month to the 3rd year of life. Laryngitis can also break out throughout the preschool or school period.

About 16% of children are reported to overcome acute laryngitis at least once. 
It affects boys more often.

This type of laryngitis has a typical seasonal occurrence. It is stimulated by the cold weather from October to March.

The disease is characterized by mild flu problems during the day. In the evening at bedtime, the picture usually worsens sharply and laryngitis is fully manifested.

The cause of inflammation is either due to the infectious agent or may have a non-infectious basis.

Non-infectious origin of inflammation:

• allergy
• physical factors
  • cold
  • heat
  • dust
• chemical
  • chemicals (accidental or deliberate poisoning)
  • gastric juices, in GERD
  • smoking - cigarette smoke
  • alcohol
  • drugs
  • smoke
  • gases
  • fumes
• vocal cord overload - vocal effort
  • long speech, singing
  • scream
• foreign body and mechanical irritation
  • after intubation - during surgery and life-threatening conditions
  • securing the airways with an endotracheal cannula
  • for the purpose of artificial lung ventilation

The winter period is risky. Cold weather is a sign of an increased incidence of laryngitis in childhood.

One of the most common is the microbial origin of inflammation. Viruses (adenovirus, RSV, or parainfluenza) are mainly used for infection. In some cases, viral inflammation can be complicated by bacterial superinfection.

Recurrence, ie recurrent infections, occurs in laryngitis. Especially in allergy sufferers, in case of weakened immunity, in case of reflux disease of the stomach and esophagus (for long-term irritation of the mucous membrane by digestive juices), but also in children with enlarged nasal - pharyngeal tonsils.

Frequently asked questions ...

Is laryngitis transmissible (contagious)?

What is the incubation time?

Answers ...

Laryngitis is caused by common viruses that are transmitted by droplet infection. And thus by inhalation. Coughing, sneezing, or direct contact is common routes of infection.

The incubation period, as in the case of influenza, can be short, ie within hours or days. Trouble breaks out from full health. Alternatively, the pre-existing rhinitis or cold may worsen.

It is important to remember that each person is different and differently susceptible to the given viruses. Not everyone immediately develops laryngitis. In children who have already had laryngitis, it is good to expect it during the season and to be prepared for this variant of the disease.

Long-term immunity remains after laryngitis.

The child is not a small adult

Therefore, even with this issue, it is not appropriate to approach this condition as in an adult. An examination by a specialist - a pediatrician - is required.

The peculiarities of children are  given by Viliam Dobiáš and the team in the book Pre-hospital emergency medicine:

• larger head and shorter neck
• nasal breathing, especially in newborns and infants - rhinitis, swelling of the nasal cavity are a problem
• saliva  is produced to a greater extent, the risk of aspiration in unconscious children
• the tongue is larger in relation to the oral cavity
• larynx - larynx is in a higher position and in front
  • in children, the subglottic area is the narrowest place
• the laryngeal flap is longer, softer in a U-shape
• trachea - trachea is shorter - the risk of unilateral intubation 
• bronchi recede at approximately the same angle, possible transmission of respiratory phenomena during unilateral intubation - difficult control
• the mucous membrane of the respiratory tract is more sensitive and swells rapidly
• higher risk of laryngospasm - laryngeal contraction
• respiratory exertion in younger children is more exhausting
• the need for oxygen is relatively higher in childhood
  • therefore, children have a faster respiratory rate
  • slowed breathing leads more quickly to hypoxia - insufficient oxygenation of tissues and organs

Interesting information:  A child is not a miniature adult! What are the differences?

The symptoms of the disease usually start from full health. Sometimes they can develop an ongoing inflammation of the upper respiratory tract, such as a cold, cold.

During the day, the problems are mild, flu-like. Characteristic of the outbreak and deterioration of disease symptoms in the evening. The manifestation of the symptoms occurs within a few minutes.

The mucous membrane of the larynx is affected to a greater extent. However, the most significant problem is swelling in the subglottic area. That is, in a place under the laryngeal flap. This is the place with the smallest translucency, ie the inner diameter.

This narrowing is all the more significant in childhood. The swelling affects the mucosa and the submucosal space.

In children, there is a higher amount of submucosal ligament in the subglottic area, and this easily responds to inflammation by swelling.

Narrowing of the area by 1 millimeter = 50 - 70% of the area.

Symptoms of laryngitis (table)

Sore throat and painful swallowing are not present.

Unless there is a significant swelling of the mucosa and a more significant restriction of the passage of air, the person, and thus the child, is in a relatively good condition. However, deterioration can occur within minutes. And especially at night.

The warning signs of the risk of respiratory (breathing) failure:

1. behavior change irritability, agitation significant restlessness
2. on the contrary, significant fatigue
3. marked pallor to cyanosis
4. weakening of wheezing as a manifestation of severe degree
5. weakening of the auscultation finding - when listening with a stethoscope - silent lungs
6. involvement of rocking heads - neck muscles during forced breathing
7. first, the enormous involvement of the respiratory muscles
   • later - relief of softening of the soft parts of the chest
8. asynchronous breathing movements of the chest and abdomen
9. disorder of consciousness

The Downes score is used to assess the overall condition of obstruction (obstruction) and acute subglottic laryngitis.

The table shows the Downes score

Evaluation of Downes score by experts:

1. less than 3 - the child is also followed by the parents, home treatment is possible
   • cool and humid air
   • plenty of fluids
   • mucus cough medicines, antihistamines, or sedatives
2. is equal to 3 to the 7 - is hospitalized and hospital treatment or transportation of emergency medical service
   • corticoids - dexamethasone iv treatment
   • sedatives
   • antihistamines
   • inhalation of adrenaline 
3. more than 7 - transport by emergency medical service and hospital treatment
   • tracheal intubation during inhalation anesthesia (with a narrower cannula of 0.5 to 1 mm)
   • if this is not possible, then coniotomy
   • iv treatment, intravenous, parenteral treatment
   • corticoids, antihistamines, analgesia, parenteral nutrition

Another form of laryngitis is known to be mild, moderate, and severe.

Mild form - occasional barking cough, during exercise also occasional whistling when inhaled. No inspirational stridor in the room.

The moderate form is characterized by whistling even in peace. Plus, there is skin retraction in the jugular area, i.e. the skin of the neck above the chest. 

In severe form, there is a marked barking cough, skin tightening at the jugula or on the chest - intracostal spaces, and restlessness of the child. 

In diagnosis, a thorough history is taken. Furthermore, the evaluation of the clinical picture and the physical examination are important. Evaluation of the condition of the oral mucosa, tonsils, laryngeal flap, and auditory findings in the lungs.

It is also necessary to notice the behavior of the person concerned, the child, his position or is able to swallow, and other listed symptoms.

Laboratory examination is not significantly necessary. Alternatively, a rapid CRP test is performed.

It is necessary to distinguish another cause of difficulties, ie differential diagnosis. Then endoscopic examination - laryngoscopy is appropriate. Airway obstruction (impaired patency) also occurs for other reasons.

Other causes of airway narrowing:

• acute tonsillitis
• abscess
• phlegmon or abscess
• acute epiglottitis
• allergic reaction
• inhalation of a foreign body - aspiration
• injury
• tumor
• hereditary angioedema - a congenital hereditary disease

For more information, see the article on the symptoms of sore throat.

It is typical that the disease develops very quickly from full health. Alternatively, it may be a worsening of another upper respiratory tract infection within a few days.

Mild flu symptoms may be present during the day. Such as fatigue, rhinitis, elevated body temperature to 38.5 ° C.

However, at night - often during sleep, the symptoms appear in the full picture of acute subglottic laryngitis. In young children, there is a higher presumption of a worse course due to the anatomical peculiarities of this period.

Significant barking, dry cough, wheezing, ie stridor when inhaling and restlessness, tightening of the skin over the chest and chest = they present a moderately severe form.

In this case, immediate professional examination and treatment is required.

Other difficulties are associated with quiet speech, or the child is not able to sound. Sore throat and impaired swallowing may not be present at all.

Difficulties usually subside within three days.