Causes
The most common cause of laryngitis is viral infections, less often bacterial. They cause inflammation in the laryngeal mucosa, which is accompanied by characteristic changes in the tissues. Narrowing of the larynx is caused by three pathogenetic mechanisms:
- swelling of the mucous and submucosal layer;
- spasm of constrictor muscles;
- obstruction of the larynx with copious mucous discharge (sputum), which is secreted by glandular cells.
The non-infectious nature of false croup is also possible. In some cases, it is provoked by allergic reactions, although they are more characterized by inflammation of the bronchi with the formation of asthma, rather than false croup.
False croup in a child one year old or earlier may be associated with the consequences of birth trauma or hypoxia during childbirth, which makes the body less resistant to external influences.
What to do after a coughing attack?
In the room where the baby spends time, you need to constantly maintain a flow of cool and humid air. If you have a humidifier, it should be running constantly. You can place a pillow under the mattress on the side of your baby's head to give him an inclined sleeping position. You need to prepare more warm drinks.
If you don't have a nebulizer at home, we highly recommend purchasing one. When treating laryngitis, inhalation is your indispensable assistant, and this device works much more effectively than simple steam breathing. Remember that ultrasound is not suitable, since the pulmicort is destroyed in it. It is best to buy a mesh inhaler - they are so compact that they even fit into your pocket, and this is very convenient if you need to go on a trip or travel.
And, of course, if your baby has an attack, you need to make an appointment with a pediatrician as soon as possible to determine the cause and quality treatment. If your child has other symptoms of illness, such as fever, or feels unwell, it is better to call a pediatrician at home. In other cases, the pediatrician can see the patient in the clinic.
Symptoms of false croup
There is a classic triad of symptoms characteristic of false croup:
- hoarseness of voice;
- noisy breathing (stridor);
- "barking" cough.
Inspiratory shortness of breath develops, making it difficult to inhale. With infectious croup, all the signs of the underlying disease are present. Usually this is fever, catarrhal phenomena in the nasopharynx, and swollen lymph nodes. False croup can occur without fever - the features of the clinical picture depend on the type of pathogen. A symptom of false croup in children is usually anxiety associated with fear due to lack of air and a painful cough.
Severity of false croup
The severity of symptoms depends on the degree of narrowing of the larynx. There are 4 of them in total:
- I: inspiratory dyspnea occurs only with crying or physical exertion. Auscultation reveals isolated dry rales during prolonged inspiration.
- II: shortness of breath appears at rest, it is accompanied by agitation and tachycardia. With the development of oxygen deficiency, cyanosis of the nasolabial triangle appears. Auscultation reveals dry wheezing.
- III: severe shortness of breath, retraction of the so-called “yielding” places (epigastrium, intercostal space, jugular fossa) is noted. Oxygen starvation increases, which causes general cyanosis of the skin. Tachycardia and threadlike pulse are noted, heart sounds are muffled. Excitement gives way to lethargy and confusion. In the lungs, upon auscultation, abundant wheezing of various sizes is detected. A bad prognostic sign is the addition of an expiratory component to shortness of breath, when not only inhalation, but also exhalation becomes difficult.
- IV: stridor and barking cough disappear, breathing becomes shallow, arrhythmic, heart rate slows, and blood pressure drops. Hypoxia increases, the patient loses consciousness, and coma may develop. If the lumen of the larynx is completely blocked, asphyxia and death are possible.
The most dangerous complication of false croup is asphyxia, but prolonged hypoxia can also cause certain disturbances in the functioning of internal organs, which is why it is so important to begin timely and adequate therapy.
If you experience similar symptoms, consult your doctor
. It is easier to prevent a disease than to deal with the consequences.
Differential diagnosis
Acute epiglottitis is a form of acute laryngitis, often of bacterial etiology, in which the epiglottis is affected. It is characterized by a sudden onset, the body position is with the head thrown back and the mouth open, there is difficulty swallowing, drooling, and fever.
Peritonsillar, parapharyngeal, retropharyngeal abscesses are purulent inflammation in the oropharynx. It is characterized by sore throat on the affected side, nasal sound, difficulty opening the mouth (trismus of mastication), drooling, stiff neck, and fever.
Allergic edema (acute angioedema). Characterized by a rapid onset without preceding symptoms of a cold or fever, swelling of the lips and tongue, rash (urticaria), and dysphagia (difficulty swallowing) are observed.
Diagnosis of false croup
Diagnosis of false croup is usually not difficult, since its clinical picture is very characteristic. It is important to exclude true croup caused by diphtheria, since it is much more dangerous and requires specific therapy. To do this, a smear is performed to check for the presence of Loeffler's bacillus (BL smear).
To properly treat false croup, you need to know what disease caused it. To do this, you can also perform a smear or evaluate the nature of inflammation using the results of a clinical blood test. To determine the degree of stenosis, the ENT doctor performs laryngoscopy. To detect hypoxia and determine its degree, pulse oximetry or other methods for assessing blood gas composition can be used.
It is necessary to differentiate false croup from a foreign body, tumors, epiglotitis, retropharyngeal abscess and other conditions that impair the patency of the larynx.
Prevention
Prevention of this condition consists of preventing the development of acute respiratory infections, and in case of illness, adequate and timely treatment. The main thing in this situation is the correct microclimate in the room where the patient is. Namely, humid (60–65%) cool (18–20°C) air, regular ventilation of the room (every hour for 15 minutes), and drinking plenty of fluids.
Children prone to allergic diseases should avoid contact with potential allergens.
If false croup has developed once, parents should keep in mind that it may recur, and, after consulting with a doctor, stock up on medications that may be useful if the disorder occurs.
Treatment of false croup
The goal of treatment for false croup is to restore the patency of the larynx, which requires reducing swelling and spasm and removing sputum. The most effective first aid method for false croup is inhalation. They are performed with regular saline or with mucolytics, which facilitate the discharge of sputum. Moisturizing the mucous membranes has a beneficial effect on their condition and quickly reduces the symptoms of croup. At the same time, you need to make breathing as easy as possible - remove tight clothes, open windows, give the patient an elevated, semi-sitting position. Treatment of false croup in children necessarily includes taking sedatives, since strong crying increases shortness of breath and aggravates the condition.
In case of severe attacks, oxygen inhalations are carried out, sometimes they resort to provoking vomiting, since the vomiting and respiratory centers are located nearby. This method must be used carefully, especially in children, as there is a high risk of aspiration of vomit.
Drug therapy for false croup consists of prescribing antitussives and antihistamines. To suppress cough, drugs are used that act centrally on the cough reflex, and not mucolytics, which, by increasing the amount of sputum, can aggravate the condition. Antihistamines effectively fight swelling, which helps to quickly increase the lumen of the larynx.
Etiotropic treatment of false croup consists of prescribing antiviral or antibacterial agents, depending on the infection that caused it. In case of febrile fever, antipyretics must be prescribed. This will help improve your general condition, which is important for normalizing breathing. To reduce swelling, “distracting” procedures are recommended - mustard plasters on the calf muscles, cupping on the back, hot foot baths.
Treatment of false croup at home is possible only for its degrees I and II. Severe attacks that last more than 20 minutes require qualified medical care, possibly hospital treatment, so you should definitely call an ambulance.
Folk remedies for the treatment of false croup can be used as auxiliary ones, since their effectiveness is significantly lower than that of official medicine. Medicinal herbs and products with anti-inflammatory and anti-edematous effects are used. It is recommended to drink plenty of alkaline mineral waters and dried fruit compotes.
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