El pediatra de Atención Primaria y la laringitis aguda / Primary care pediatrician and acute laryngitis

La laringitis aguda (crup) es una enfermedad común de origen viral, que constituye la causa más frecuente de obstrucción de la vía aérea superior en la infancia. Se caracteriza por la presencia de un grado variable de tos perruna o metálica, afonía, estridor y dificultad respiratoria. La incidencia estimada es del 3-6% de niños entre 3-6 meses y 6 años, con un pico máximo en el segundo año de vida y durante el otoño y el invierno. La principal causa es el virus parainfluenza tipo 1. El diagnóstico se realiza por la clínica, tos perruna, afonía y estridor inspiratorio. No son necesarias otras exploraciones. En función de la gravedad, que estableceremos con un score clínico, pautaremos el tratamiento. El tratamiento farmacológico será a base de corticoides y adrenalina en las laringitis moderadas y graves. La dexametasona oral es el corticoide de elección en todos los casos. (AU)

Acute laryngitis/croup is a common disease of viral origin, which is the most frequent cause of upper airway obstruction in childhood. It is characterized by the presence of a variable degree of dog or metal cough, aphonia, stridor and respiratory distress. The estimated incidence is 3-6% of children between 3-6 months and 6 years, with a peak in the second year of life and during the autumn and winter. The main cause is the parainfluenza virus type 1. The diagnosis is made based on the symptoms, barking cough, hoarseness and inspiratory stridor. No other examinations are necessary. Depending on the severity, which will be objectively established with a clinical score, will the treatment be prescribed. Oral corticosteroids are the treatment of choice in all diagnosed children. Pharmacological treatment is corticosteroids and adrenaline in moderate and severe laryngitis. Oral dexamethasone is the corticosteroid of choice in all cases. (AU)

Iron Pill-Induced Chemical Laryngitis.

OBJECTIVE: To discuss the presentation and management of pill-induced chemical laryngitis by illustrating a rare case. METHODS: We report a unique case of a patient with iron pill-induced laryngitis. RESULTS: A 71-year-old male presented for evaluation of dysphonia. Five weeks prior, the patient had reportedly aspirated an iron pill. The pill was lodged in his throat for several hours before being coughed up, soft but still intact. Since that event, the patient noted complete voice loss and in clinic was found to have a very breathy and asthenic voice. Stroboscopy revealed aperiodicity with severe false fold compression and significant ulceration of the infraglottic region associated with thick exudate. Vocal folds were mobile but atrophic, with overlying crusted secretions. A sensory deficit was suspected based on scope tolerance. The patient was treated with nebulized ciprodex and humidified air with some improvement in mucosal crusting but had persistent glottic insufficiency and dysphonia, prompting bilateral hyaluronic acid injection. CONCLUSIONS: Pill-induced laryngitis is an extremely rare phenomenon. While typically associated with bisphosphonates, this condition should be considered in any patient presenting with dysphonia and history of aspiration of a pill, including iron supplements. Regardless of the inciting medication, pill-induced laryngitis may be treated with humidified air, nebulized steroids, and antibiotics. Injection augmentation of the vocal folds may be made considered when glottic insufficiency and weak cough contribute to the presentation.

[Results of a prospective observational study of the effectiveness of the complex drug Homeovox in adult patients with various types of dysphonia]. / Rezul'taty prospektivnogo nablyudatel'nogo issledovaniya effektivnosti kompleksnogo lekarstvennogo preparata gomeovoks u vzroslykh patsientov s razlichnymi vidami disfonii.

The voice as the most important means of communication is of great importance in a person's life. Every year the number of specialties for which voice and speech are a key tool of professional activity increases. Diseases of the vocal apparatus reduce the ability to work, and for some people pose a threat of professional unfitness. The relevance of the study is determined not only by the significant prevalence of dysphonia, but also by the insufficient effectiveness of existing methods of treating voice disorders. OBJECTIVE: To evaluate the clinical efficacy and safety of the use of the drug Homeovox in patients with acute and chronic catarrhal laryngitis as monotherapy. To fulfill the set goal of the study, the following tasks were solved: evaluation of the clinical effectiveness of the drug Homeovox as monotherapy for various types of dysphonia; evaluation of the effectiveness of the drug Homeovox as monotherapy from the 1st day of use. MATERIAL AND METHODS: The basis for the implementation of the tasks was the analysis of the results of the examination and treatment of 60 patients with voice disorders aged 18 to 75 years. Among them, 10 (17%) patients with acute laryngitis and 50 (83%) patients with chronic laryngitis. To establish the diagnosis, a comprehensive examination was carried out, involving examination, videolaryngostroboscopy, acoustic analysis of the voice. The study design included three patient visits, during which the functional state of the vocal apparatus was examined by subjective and objective methods. RESULTS: As a result of the treatment with the use of the drug Homeovox, the efficacy and safety of this drug in the treatment of dysphonia in adult patients with acute and chronic laryngitis from the first days of therapy has been proven, which is confirmed by the method of videolaryngostroboscopy and acoustic analysis of the voice. CONCLUSION: The drug Homeovox is an effective, safe remedy and can be included in the complex treatment of laryngeal pathology in order to increase its effectiveness and achieve a therapeutic effect in a shorter time, manifested by an improvement in the clinical and functional state of larynx.

Primary fungal laryngitis mimicking recurrent laryngeal carcinoma.

A 79-year-old smoker with a background history of a treated glottic carcinoma and chronic obstructive pulmonary disease presented with progressive hoarseness, symptoms of aspiration and shortness of breath for 6 months. Examination revealed an ulcero-fungating mass over the posterior commissure of the larynx. A tracheostomy, direct laryngoscopy and biopsy of the mass was performed to secure his airway and to exclude recurrent glottic carcinoma. Reassuringly, a histopathological examination of the mass revealed numerous fungal yeast bodies. He was then treated with itraconazole for 4 weeks and was followed up as and outpatient with complete resolution and no recurrence of the disease.

Isolated Aspergillus Laryngitis: Spectrum, Management, and Review of Literature.

PURPOSE: Isolated aspergillus laryngitis is rare and often diagnosed after surgical excision or biopsy for a suspected premalignant or malignant pathology. Unlike other systemic or localized aspergillosis, there are no specific guidelines for isolated laryngeal aspergillosis. Our experience of dealing with a wide variety of isolated laryngeal aspergillosis showed that this entity is very responsive to medical therapy, making extensive debridement (as often carried out in surgically accessible aspergillosis) unnecessary as it would invariably lead to long-term dysphonia. MATERIALS AND METHODS: A retrospective analysis of all cases of isolated aspergillus laryngitis that presented to our hospital over the past 5 years was carried out. All patients with confirmed histopathological diagnosis of aspergillus infection were included. RESULTS: Twelve patients (five males and seven females) aged 28-54 years, who were diagnosed with aspergillus laryngitis presented with dysphonia. The most common involved site was the true vocal cords. All patients underwent cautious biopsies either in the operating theatre or in-office using a channeled fiber-optic laryngoscope. On histopathological examination, eight had invasive aspergillus infection while others showed variety of noninvasive involvement including colonization of cysts and carcinoma in situ. The most common species isolated was Aspergillus fumigatus. Appropriate antifungal chemotherapy was prescribed after ruling out systemic involvement. None of the patients showed recurrence or residual lesions on follow-up and reported significantly improved voice. CONCLUSIONS: This study highlights the wide spectrum of presentation of isolated aspergillus laryngitis with Aspergillus fumigatus being the most common organism isolated. Even the invasive variant is a medically treatable condition with voriconazole being the drug of choice. The importance of cautious biopsies and resections for voice preservation is also emphasized. To our knowledge, this is the largest report on isolated aspergillus laryngitis.

[Chronic catarrhal laryngitis in singers]. / Khronicheskii kataral'nyi laringit u vokalistov.

The article deals with optimization of treatment policy for singers with chronic catarrhal laryngitis. The survey sample is 51 singers with chronic catarrhal laryngitis of the age from 29 to 54 and the length of time worked from 8 to 22 years. The following methods are used: anamnesis, microbiological investigation, voice evaluation according to Visual Analog Scale (VAS), microlaryngoscopy, videolaryngostroboscopy, voice acoustic analysis (MDVP Kay Pentax system), statistical processing of results. It is shown that the cause of chronic catarrhal laryngitis in professional singers is non-bacterial irritants that provoke the appearance of an inflammatory process in the larynx, as well as uncontrolled use of drugs that irritate and dry out the mucous membrane and imperfect vocal technique. Pathogenic flora as an etiologic factor in the occurrence of laryngitis does not play an important role. A comprehensive treatment scheme for chronic catarrhal laryngitis using inhalation therapy and drugs that improve trophic processes in the laryngeal mucosa, which allows to increase the effectiveness of treatment and achieve stable remission of the disease, is suggested.

Efficacy of inhaled budesonide on serum inflammatory factors and quality of life among children with acute infectious laryngitis.

OBJECTIVE: Acute infectious laryngitis is commonly occurred among children. Our study sought to investigate the effect of inhaled budesonide on among children with acute infectious laryngitis. METHODS: A total of 92 children with acute infectious laryngitis were randomly allocated to either the study (46 cases, treated with inhaled budesonide) and control group (46 cases, treated with dexamethasone). The disappearance time of symptoms, therapeutic effect and adverse reactions were observed in the two groups. RESULTS: The therapeutic effect was significantly better in the study group than in the control group (97.83% vs 82.61%). After 3 days of treatment, the disappearance time of symptoms, such as hoarseness/barking cough, singing sound in the throat, three-concave sign and dyspnea in the study group was significantly less than that in the control group (P < 0.05). The levels of IL-4, IL-17, MMP-9, IL-33, IFN-γ and IgE in the two groups decreased, and evidently lower levels were found in the study group as compared to the control group (P < 0.05). CONCLUSION: Inhaled budesonide exerted obvious better effect in terms of reducing serum inflammatory factors and improving the quality of life with safety profile.

Characteristics and Voice Outcomes of Ulcerative Laryngitis.

OBJECTIVES: Ulcerative laryngitis (UL) is challenging in terms of treatment and patient counseling, with few reports in the literature. This study describes UL patients and their clinical course including detailed voice and stroboscopic outcomes after treatment which have not been described in previous literature. METHODS: Single-institution, retrospective review of 23 UL patients. Demographics, historical factors, disease course, treatment, and outcomes are presented. Treatment results were compared to prior studies. RESULTS: Seventy four percent had inflammatory/infectious precipitating event. Average presenting Voice-Handicap-Index-10 (VHI-10) was 25 (range: 6-38) and average final VHI-10 was 9 (range: 0-26). Ninty five percent had improvement in VHI-10 (average decrease of 15). Only 50% had final VHI-10 within "normal" limits. Treatment comprised reflux medications (85%), antibiotics (22%), antifungals (39%), antivirals (52%) steroids (52%), and/or voice rest (65%). Average symptom duration before evaluation was 42 days; average follow-up was 6.8 months. Final laryngovideostroboscopy revealed no ulcers in 78%, but 65% had persistently decreased mucosal wave vibration. Average time to ulcer resolution was 2.25 months but resolution or plateau of voice symptoms occurred later, average 2.7 months. Multiple regression analyses revealed that younger age, shorter symptom duration, and antireflux treatment were significant predictors of decrease in VHI-10 (P < 0.05). CONCLUSIONS: Most patients have good voice outcomes following resolution of UL, although vocal fold mucosal wave abnormalities may persist. This study provides the most detailed report of UL, disease course and treatment outcomes to date. Additionally, this study is also the first to suggest that earlier initiation of treatment may improve voice outcome after UL.

A case report of Talaromyces marneffei Oro-pharyngo-laryngitis: a rare manifestation of Talaromycosis.

BACKGROUND: The incidence of Taralomyces marneffei infection in HIV-infected individuals has been decreasing, whereas its rate is rising among non-HIV immunodeficient persons, particularly patients with anti-interferon-gamma autoantibodies. T. marneffei usually causes invasive and disseminated infections, including fungemia. T. marneffei oro-pharyngo-laryngitis is an unusual manifestation of talaromycosis. CASE PRESENTATION: A 52-year-old Thai woman had been diagnosed anti-IFNÉ£ autoantibodies for 4 years. She had a sore throat, odynophagia, and hoarseness for 3 weeks. She also had febrile symptoms and lost 5 kg in weight. Physical examination revealed marked swelling and hyperemia of both sides of the tonsils, the uvula and palatal arches including a swelling of the epiglottis, and arytenoid. The right tonsillar biopsy exhibited a few intracellular oval and elongated yeast-like organisms with some central transverse septum seen, which subsequently grew a few colonies of T. marneffei on fungal cultures. The patient received amphotericin B deoxycholate 45 mg/dayfor 1 weeks, followed by oral itraconazole 400 mg/day for several months. Her symptoms completely resolved without complication. CONCLUSION: In patients with anti-IFN-É£ autoantibodies, T. marneffei can rarely cause a local infection involving oropharynx and larynx. Fungal culture and pathological examination are warranted for diagnosis T. marneffei oro-pharyngo-laryngitis. This condition requires a long term antifungal therapy.

Topical Ectoine: A Promising Molecule in the Upper Airways Inflammation-A Systematic Review.

To date, topical therapies guarantee a better delivery of high concentrations of pharmacologic agents to the mucosa of the upper airways (UA). Recently, topical administration of ectoine has just been recognized as adjuvant treatment in the Allergic Rhinitis (AR) and Rhinosinusitis (ARS). The aim of this work is to review the published literature regarding all the potential therapeutic effects of ectoine in the acute and chronic inflammatory diseases of UA. Pertinent studies published without temporal limitation were selected searching on MEDLINE the following terms: "ectoine" and "nasal spray," "oral spray," "upper respiratory tract infections," "rhinosinusitis," "rhinitis," "rhinoconjunctivitis," "pharyngitis," and "laryngitis." At the end of our selection process, six relevant publications were included: two studies about the effect of ectoine on AR, one study about ARS, one study about rhinitis sicca anterior, and two studies about acute pharyngitis and/or laryngitis. Due to its moisturizing and anti-inflammatory properties, topical administration of ectoine could play a potential additional role in treatment of acute and chronic inflammatory diseases of UA, in particular in the management of sinonasal conditions improving symptoms and endoscopic findings. However, these results should be viewed cautiously as they are based on a limited number of studies; some of them were probably underpowered because of their small patient samples.

Hoarseness Guidelines Redux: Toward Improved Treatment of Patients with Dysphonia.

The Hoarseness Guideline Update provides an evidence-based approach to a patient who presents to the clinic with hoarseness. The guidelines cover management decisions in acute and chronic dysphonia for patients of all ages before and after laryngeal examination. The present review discusses the process used to develop these guidelines, including limitations of the process and each key action statement.

Post-transplantation laryngeal actinomycosis.

A case of laryngeal actinomycosis occurred after bone marrow transplantation was reported. The patient was a 14-year-old girl who had a history of bone marrow transplantation for the treatment of acute lymphocytic leukemia 4month before the onset of the disease. She was referred to our hospital complaining persistent sore throat since 2weeks ago. Fiberscopic observation proved the presence of white tumor-like mass on her right arytenoid of the larynx. As CT image demonstrated that the mass was localized at the arytenoid region with central low-density area surrounded by granulation tissue, we underwent biopsy under local anesthesia. Excision of the mass proved it to be a soft granulation including sulfur granules. Oral administration of amoxicillin 750mg per day was initiated as a postoperative medication. On day 17, histological study confirmed that the tumor-like mass was Actinomyces granuloma, and therefore amoxicillin administration continued. The medication was effective to subside the disease and the arytenoid lesion healed on day 31. Amoxicillin was further administered until day 70 to prevent recurrence. At 6month after the biopsy, she was free from the disease.

Anthroposophic medicine in the treatment of pediatric pseudocroup: A systematic review.

BACKGROUND: In Europe only few integrative pediatric wards exists and there are two German hospitals focusing on anthroposophic medicine as part of complementary and alternative medicine (CAM). Whilst the most common pediatric diseases are treated here, pseudocroup patients make up a large group in these hospitals, receiving conventional as well as anthroposophic therapies. However, effectiveness of these therapy concepts mostly based on physicians' experiences but clinical studies are hitherto missing. METHODS: A systematic literature search identifying therapy approaches for pseudocroup in children was conducted in general electronic databases (Cochrane Library, PubMed, OVID) and in CAM-specific databases (CAMbase, CAM-QUEST®, Anthromedics). Search results were screened for anthroposophic therapy options. In addition, anthroposophic guidebooks were handsearched for relevant information. RESULTS: Among 157 articles fulfilling search criteria one retrospective study, and five experience reports describing anthroposophic treatments were identified. Several medications for the treatment of pseudocroup were mentioned such as Aconitum, Apis, Bryonia, Hepar sulfuris, Lavender, Pyrit, Sambucus and Spongia. During appropriate use no adverse effects were reported. CONCLUSION: Anthroposophic medicine harbors a broad spectrum of remedies for the treatment of pseudocroup in children. In particular, Aconitum, Bryonia and Spongia are frequently recommended; however, clinical trials investigating the effectiveness are sparse. Therefore, development and validation of therapy strategies are required.

[The treatment of laryngomycosis]. / Lechenie laringomikoza.

The objective of the present study was to elaborate the therapeutic algorithm for the treatment of laryngomycosis. We have examined a total of 430 patients suffering from chronic laryngitis including 100 ones (23.2%) having the fungal flora. Mycosis was diagnosed by the microscopic study of the stained preparations with the application of various techniques; moreover, cultivation in elective nutrient media was used. The yeast-like fungi of the genus Candida were identified in 98 (98%) and mold fungi of the genus Aspergillus in the remaining 2 (2%) patients. All these 100 patients were given the antifungal treatment. 98 of them presenting with candidal laryngitis were allocated to three groups. Group A was comprised of 33 patients who received the local treatment alone, group B contained 31 patients given only systemic therapy, and group C included 34 patients undergoing the combined treatment with the use of the medications possessed of both the local and systemic actions. The best clinical results were obtained in the patients of the latter group in which the therapeutic efficiency proved to be as high as 79.4%. It is concluded that all the patients suffering from laryngomycosis are in need of the combined treatment designed to eradicate the causative agent, restore the vocal function, and achieve the stable remission of the chronic inflammatory process in the larynx. The combined treatment with the antimycotic medications exhibiting both the general systemic and local activities during 3 weeks appears to be the optimal therapeutic modality for the management of laryngomycosis. Of special importance is the dynamic follow-up of the treated patients including the control examinations in the course of the treatment (days 7, 14, and 21) to be followed by the mycological study after the termination of therapy and its repetition every 3 months during the subsequent period.

Isolation of Mycobacterium arupense from pleural effusion: culprit or not?

BACKGROUND: Mycobacterium arupense, first identified in 2006, is a slow-growing nontuberculous mycobacterium (NTM) and an emerging cause of tenosynovitis, potentially associated with immunosuppression. However, unlike the diagnostic value of its isolation from osteoarticular specimens, the significance of detecting M. arupense in respiratory specimens is not yet clear. CASE PRESENTATION: To our knowledge, we, for the first time, described the identification of M. arupense from the pleural effusion of an immunocompetent patient, who presented with fever and chylothorax. The symptoms resolved with doxycycline treatment for 45 days and a low-fat, high-protein diet. Follow-up at 14 months showed no relapse. CONCLUSIONS: Because the patient fully recovered without combined anti-NTM treatment, we did not consider M. arupense the etiological cause in this case. This indicates that M. arupense detected in pleural effusion is not necessarily a causative agent and careful interpretation is needed in terms of its clinical relevance.