Answers:
1. The most probably diagnosis is: Acute non-specific laryngitis causing stridor.
Reasons:
• The stridor is laryngeal because it`s inspiratory.
• Hoarseness of voice & cough indicates laryngitis.
• Laryngitis in children usually present with obstruction.
NB:
Acute non-specific laryngitis is acute inflammation in laryngeal mucosa.
It is associated with upper respiratory infection (mostly common cold).
It starts viral infection then secondary bacterial infection.
The most predisposing factor is low general resistance and pollution, but in adult may be due to vault use of voice.
The main symptom in children is stridor.
2. Acute non-specific laryngitis in children more dangerous as it causes stridor, this is due to the following factors:
a) The larynx is small in children (easy obstruction).
b) The submucosa of larynx in children is loose (easy for oedema).
c) The larynx in children is funnel-shaped with narrow subglotic area (easy for obstruction).
d) The laryngeal cartilage in children are softer (easy for collapse).
3. Differential diagnosis:
a) Laryngeal diphtheria:
• Gradual onset of low grade fever 38?C
• Pulse is not proportionate to the fever.
• Marked enlarged lymph node( bull neck)
• Diphtheric memberane: unilateral, not limited to tonsillar margin.
b) Acute epiglottitis:
• Inflammation starts by severe sore throat & child can`t swallow his own saliva leadind to drooling.
• High fever 40?C.
• Muffled voice then severe stridor.
• The epiglottis is markedly swollen & congested.
• X-ray lateral view of the neck showing swollen epiglottis.
4. Treatment:
HOSPITILIZATION and take the following measurements:
A) Systemic antibiotic by injection.
B) Steroid: to decrease inflammatory oedema in laryngeal mucosa.
C) Supply oxygen by inhalation.
D) Steam inhalation with tincture benzoine.
E) If all that failure, save the airway by:
• Endotracheal intubation.
• Tracheostomy in severe stridor.
