Laryngeal obstruction in children (兒童喉阻塞)

Clinical features:

The hallmark of laryngeal obstruction is stridor. Inspiratory stridor indicates glottic or supraglottic obstruction, expiratory stridor bronchial obstruction and two-way stridor subglottic obstruction. If stridor is accompanied by cyanosis, tachycardia and intercostal and sternal recession, urgent measures are needed to save life. In less severe cases a hoarse voice, feeding problems and recurrent chest infections may occur.

Congenital laryngeal obstruction (先天性喉阻塞)

Aetiology:

Congenital anomalies include laryngeal cysts, webs, stenosis, vascular rings and vocal cord paralysis. Laryngomalacia is a condition caused by abnormal flaccidity of the larynx allowing the supraglottic structures to be drawn into the airway on inspiration; the condition resolves with age.

Management:

All cases of congenital stridor should undergo direct laryngoscopy.

Acquired laryngeal obstruction (後天性喉阻塞)

Aetiology:

• Acute epiglottitis – due to Haemophilus influenzae. It causes rapidly progressive airway obstruction.
• Acute laryngotracheobronchitis (croup) – due to para-influenzae virus or respiratory syncytial virus. It produces oedema, exudates and crusting of the larynx, trachea and bronchi.
• Subglottic stenosis – may follow infant tracheostomy or prolonged endotracheal intubation.

Management:

• Acute epiglottitis – treatment is with intravenous chloramphenicol. Endotracheal intubation or an emergency tracheostomy may be necessary.
• Acute laryngotracheobronchitis – endotracheal intubation is rarely required.