Stenosis of the larynx in children Komarovsky

Causes of laryngeal stenosis in laryngitis

Laryngitis is an inflammatory process that occurs in the larynx. This disease is characterized by a dry, barking cough and hoarseness. As a rule, this disease is a consequence of various viral infections and occurs mainly in children. However, the most dangerous condition is laryngitis with stenosis, which is also called croup syndrome. When this occurs, the larynx narrows, which requires emergency medical care.

Acute laryngitis usually has a viral nature, but sometimes viral-bacterial forms of the disease are also observed. As a rule, this disease is detected in children under three years old, with boys more often than girls. False croup may have varying degrees of severity – in the under-lump space of the larynx, ordinary edema most often occurs, but in some cases ulcerous-necrotic lesions develop.

Acute laryngitis is often manifested by narrowing, or stenosis, of the larynx. This occurs as a result of swelling and muscle spasm. The factors that lead to the development of stenosis can be different:

1. Infectious causes:

  • viral pathologies – influenza, ARVI, adenovirus
  • bacterial infections – diphtheria, peritonsillar abscess, epiglottitis.
  • 2. Noncommunicable causes:

  • foreign object, traumatic damage to the larynx, laryngospasm
  • allergic reactions – in children, they often occur on the use of honey, chemicals, inhalations with conifers.
  • Against the background of the inflammatory process, the lumen of the larynx narrows, which leads to a sharp respiratory failure. Stenosis in laryngitis usually occurs in the form of an attack. Sometimes the pathological condition develops so rapidly that the patient’s condition can become very serious within 10-15 minutes. Such an attack may appear in the middle of the disease or become its first manifestation.

    In most cases, an attack occurs suddenly – usually at night or in the evening. Symptoms of stenosis in laryngitis include:

  • hoarseness or complete loss of voice
  • stenotic breathing – is characterized by shortness of breath with difficulty breathing
  • barking cough.
  • As a person experiences difficulties with inhalation, he begins to breathe more often, inflates the wings of the nose, becomes restless. In children, the skin acquires a bluish tint and may develop asphyxiation. Sometimes an attack ends on its own, and then the child calms down and falls asleep. However, in some situations, you may need emergency assistance.

    First aid

    With the development of an attack, you must immediately call an ambulance. Before her arrival, you can perform the following actions:

    1. If stenosis of the larynx is observed in a child, you need to pick it up and try to calm it down.
    2. Provide fresh air, it is important to note that it should not be too cold.
    3. To humidify the air in the room where the patient is staying – for this purpose it is best to use a special humidifier.
    4. Hot foot baths are suitable for adults.
    5. For adults and children, you can use a compress on the throat.
    6. Give the patient an antihistamine drug – claritin, zodak, Erius.
    7. Drink a person – in this case, a warm alkaline drink is shown.

    If a patient has a painful cough, he can be inhaled:

  • alkaline inhalations – they are recommended to do 2-4 times a day for 5-8 minutes, to prepare the composition you need to dissolve a teaspoon of soda in a glass of warm water
  • inhalations with naphthyzinum – 1 ml of 0.1% solution of naphthyzine per 10 ml of saline
  • inhalation with lazolvan – 1 ampoule of the drug per 10 ml of saline, this procedure is indicated if there are difficulties with the separation of mucus.
  • If stenosis in children is accompanied by severe symptoms of difficulty breathing, the doctor may prescribe the administration of hormonal drugs – they quickly eliminate the mucosal edema and muscle spasm of the larynx.

    Also for the treatment of viral croup can be used tools that facilitate the dilution and excretion of sputum. In addition, the doctor may prescribe drugs that are aimed at combating the virus of the disease. If laryngitis occurs with bacterial complications, the use of antibiotics is indicated.

    What not to do with stenosis?

    When stenosis of the larynx in children, drugs that suppress cough are absolutely contraindicated.

    It is a protective reaction of the body, which makes it possible to clear the airways of mucus.

    In addition, you should not do inhalation with essential oils or put mustard plasters – this can cause a spasm of the muscles of the larynx and only exacerbate the manifestations of stenosis. Honey, raspberry, citrus fruits are not suitable for children who are prone to allergic reactions, since they can increase the swelling of the mucous membrane. Do not use homemade steam inhalers – there is a threat to get burns of the respiratory system.

    Stenosis of the larynx in children Komarovsky

    Prevention

    In order to prevent the development of laryngeal stenosis in children, it is necessary to engage in its prevention. Most often, this condition is accompanied by acute respiratory viral infections. Therefore, if a child has a sore throat and a dry cough, you should immediately consult a doctor. In no case in such a situation can not self-medicate. The main factor in the prevention of such attacks is the correct treatment of ARVI.

    If the stenosis of the larynx does not appear for the first time, the child must be examined and carried out his recovery in the period between the attacks. However, for this, you should also consult a doctor, because in each case an individual approach is important.

    Laryngeal stenosis is a very dangerous condition that can have unpredictable consequences. Such attacks are especially dangerous for young children. In order to prevent the development of serious complications, when the first signs of the disease appear, it is necessary to consult a qualified doctor who will provide the necessary assistance.

    Do you know what laryngitis and croup are? How can you save a child from these diseases? What are their dangers and how to treat them? Dr. Komarovsky decided to answer these questions.

    Most often this disease is caused by viruses, the development is gradual, over several days. Initially, the child develops seemingly the usual cold. About two days later, the voice becomes husky. Then there is the appearance of a “barking” cough – a rough one, having a metallic hue, resembling a dog barking. If you ever hear the sound of such a cough, you can’t confuse it with anything.

    If the treatment is carried out correctly at this stage, nothing terrible will happen. It is imperative to call the doctor, give the sick baby a lot to drink, and when the temperature rises, knock it down with the help of antipyretic, and also rub the legs and chest. Most likely, the pediatrician will be prescribed Erespal, a drug for the treatment of laryngeal stenosis in children, due to which the respiratory muscles relax, sputum recedes and breathing becomes easier.

    If the above stage of the disease is missed, the baby may develop stenosis. How to determine that stenosis is approaching? The child becomes restless, even scared. A little crying, a hoarse voice. The development of stenosis almost always occurs at night.

    The child’s breathing becomes difficult, and he experiences difficulty breathing in – this is called inspiratory dyspnea. Often the baby has to take a forced position in bed – he sits, leaning on his arms, slightly extended forward. There is a change in the color of the face, the skin is pale, and a bluish tint appears on it. This is evidence that the body lacks oxygen.

    Note that the formation of stenosis of the larynx is influenced by various factors according to its kind of origin:

  • Inflammatory development (formed on the basis of the primary disease: hovdroperichondritis of the larynx, erysipelas, laryngeal sore throat, phlegmonous laryngitis, podskladochny laryngitis).
  • Infectious diseases (scarlet fever, tuberculosis, measles, malaria, laryngeal stenosis in diphtheria, typhoid and typhus, influenza stenotic laryngotracheobronchitis, syphilis).
  • Diseases of the trachea, larynx, esophagus.
  • Exogenous: injury to the larynx caused by a surgical (medical manipulation) or a household method, foreign bodies in the larynx, burns (radiation, thermal, electrical, chemical).
  • Endogenous: congenital anomalies of the larynx and inflammatory processes, the occurrence of laryngeal tumors.
  • Allergic reaction (becomes the cause of laryngeal edema).
  • Abnormal processes: purulent processes and hematomas in the laryngeal and pharyngeal zone, the occipital and occipital spaces, in the area of ​​the cervical spine, the root of the tongue and the soft tissues of the oral cavity.
  • Disorders of motor innervation of the larynx. These include: myopathic paresis and paralysis of the laryngeal muscles, neurogenic paralysis, psychogenic stenosis, laryngospasm.
  • Poisoning of the body in acute renal failure, when urea is secreted by mucous membranes, including laryngeal. When interacting with the microflora, it is converted into ammonium carbonate, which has a destructive effect on the mucous membranes, which causes dry hemorrhagic and ulcerous-necrotic processes.
  • There are four degrees of laryngeal stenosis in children:

    Komarovsky

    There are two main reasons for such attacks. First, it is the individual anatomical features of the larynx – which is why some children have seizures (episodes of stenosis of the larynx) often, and others never have them. Secondly, it is a way of life – first of all, the parameters of the air in the room where the child sleeps. If a child has a viral infection and he went to bed in a dry and warm room, then at night mucus is highly likely to dry up at the level of the larynx, as a result – an attack of stenosis will occur. Emergency help – run to fresh air and a lot of warm drinks. To remove an attack with hormone injections is common international practice, it does not cause kidneys, and immunity does not kill. Antibiotics for the treatment of laryngitis and viral croup have nothing to do.

    Well, if such cases in the first-aid kit will be the drug Prednisolone. Even if no one knows how to give injections, there is no choice: it is necessary to give an injection, to look for a nurse or someone else simply does not have time. Laryngeal stenosis in children develops too quickly and only the time gains before the arrival of qualified assistance depends on the courage of the parents. With obvious breathing, an injection can be given to make breathing easier for the child. You just need to know for sure that there is no other choice and judge, if possible, sensibly: if the doctors are already on the way, and the hot steam and the rubbing of the legs help, the child breathes, then you should not prick the drug.

    In this case, the principle of the worst of evils acts, since such a drug does not bring anything good for the health of a small child. But if this cannot be avoided and the danger of life is high, the dosage must be observed: up to half a year, no more than half of the ampoule must be administered, the older children kiss.

    But you need to be aware that such a disease can appear more than once. There are children who have bouts of stenosis occur with every viral or catarrhal disease. That is why it is very important to learn how to cope with a dangerous opponent, suppressing panic. Otherwise, the child is simply doomed to a painful death.

    You can not go to the other extreme: the baby feel better after steaming or injection, so you should not go to the doctor anymore. Call an ambulance followed by a visit to the district pediatrician is vital for recovery. First, the seizure may recur, and you cannot prick the drug every time. The child is in dire need of good and comprehensive treatment, undergoing a course of physiotherapy, treatment with antibiotics and the elimination of laryngeal edema.

    It is necessary to monitor what exactly the child eats. Often stenosis of the larynx in children begins with an allergy to the product or to some kind of smell. We must try to convey to grandmothers who love to forget about the prohibitions of parents that a child can die if he is given chocolate that he is allergic to. True, this method is rarely used, so you need to carefully monitor the child, paying great attention to detailed questioning. With exacerbation of the disease it will help to quickly understand the root cause of the attack.

    At the time of the attack is often a critical situation, then the specialists have to perform an operation on the spot. A section is made in the area of ​​the trachea for the purpose of air intake, a special tube is inserted. You should never give up urgent hospitalization, even if the child seems almost healthy and regained her former breathing. During a crisis, constant observation is necessary and it can be ensured only in stationary conditions.

    Prevention

    Not so complicated and prevention of stenosis of the larynx. First of all, it is necessary to exclude the contact of the child with patients on acute respiratory viral infections and flu. The diet should include in sufficient quantities fresh vegetables, fruits, cottage cheese, milk, yoghurts and bifidobacteria, cereals.

    It is also important to ensure that the child does not eat foods that cause allergic reactions. In particular, grandmothers, who often love to please their grandchildren with “forbidden” sweets, should take this into account, since this can end in disrepair: stenosis can be life-threatening.

    It is absolutely forbidden to refuse medical assistance if required by a health worker. If we are talking about stenosis of the larynx, then no inconvenience, technical difficulties, anyone’s stories should not frighten you.

    Sometimes it is necessary to resort to surgery in order that the access of air to the lungs through the narrowed larynx is restored. Surgical intervention in this case is a dissection of the trachea below the place where it is narrowed, and the introduction of a special tube. It is impossible to delay in treatment, as this may entail death for the child in the form of suffocation or serious complications.

    Allergic

    A dangerous allergic lesion of the larynx in preschool children is stenosis of the larynx, or false croup. When this develops swelling in the vocal cords. As a rule, at night, without any harbingers, the child has a rough barking cough, hoarseness, difficulty noisy breathing and even choking. Laryngeal stenosis can also occur against the background of viral infections, especially with influenza and parainfluenza, but then it does not occur more than 1-2 times in a child’s life. Recurrent laryngeal stenosis in a child over the age of 3 years is still more characteristic of allergic rather than viral damage, especially if there are other manifestations of allergy.

    Stenosis of the larynx in children Komarovsky

    Like Do not like Rubashka

    Girls copied information from those who encountered:

    What you need for first aid

    1. Compression nebulizer.

    2. Naphthyzinum (for children with a dosage of 0.05%)

    4. Zyrtec or any other antihistamine.

    In most cases, stenosis occurs at night. Suddenly, against the backdrop of a sharp “barking” cough, it becomes difficult for the child to breathe, and he begins to draw in the air with a noise. This happens due to edema of the mucous membrane of the larynx, which narrows its lumen.

    If you understand that now you have an attack of stenosis, you should

    The first thing is to call an ambulance, because for the first time you cannot independently assess the degree of stenosis and the threat to the child.

    1. Wake the child.

    2. Seat him on the pillows, cover him with a blanket, open the window, so that there is fresh and cold air in the room.

    3. While one of the parents charges the nebulizer at the rate of 1k 1 saline and naphthyzine, the second one gives the child a hot water bottle to the legs (which would be blood outflow from the larynx to the legs) and 10 drops of the liquid.

    4. Breathe with naphthyzinum can be no more than 5 minutes. Then you can pour out this mixture and let the child breathe only saline.

    Personally, I do not wake Danica at first, but drip Naphthyzinum 2 drops into each nostril in his nose, and only then wake him up and let him just breathe with saline. You can do so.

    And the first attacks while I called an ambulance and my nebulizer refueled the husband carried the sleepy Danik to the bath and they kept the legs in warm water. They put a high chair right in the bath and poured water on the ankle, while still rubbing handles in this water. But that is if there is no temperature. And you can just bring a hot water bottle to the bed with warm water, as we began to do later.

    This is the first thing we can help the child while waiting for an ambulance.

    Girls, supplement, correct me.

    Doctors also do not recommend giving anything that can cause allergies during stenosis, since stenoses are allergic and foods can provoke more attacks.

    First of all antihistamine inside, naphthyzine drip into the nose and splash Tantum verde into the throat.

    And I immediately gave Clenbuterol and Erespal. Before the second seizure, she performed all this therapy before bedtime and the seizure occurred half an hour after the child fell asleep.

    Stenosis of the larynx in children Komarovsky

    By the way, stenosis most likely will occur in any disease with abundant discharge – snot, sputum. Therefore, in these cases it is necessary to make cool and moist air in the room to prevent an attack. Well, remove the swelling of the mucous before bedtime.

    First aid for false croup. (Laryngospasm)

    Laryngitis and laryngotracheitis per se do not pose a serious danger, but in some cases they are complicated by attacks of false croup. Acute stenosing laryngotracheitis or false croup – a disease characteristic of children from six months to two or three years. Until now, the mortality from this disease is quite large. Often, mothers simply get lost when a child has a stenosis attack, lose precious minutes, unable to recognize the onset of the disease in time, or, of course, provide the necessary help.

    Basic terms to make it clear:

  • Stenosis and obstruction – in this case, mean the very narrowing of the subglottic space, which is caused by swelling of the mucous membrane.
  • Auxiliary muscles are muscles that are not involved in breathing in a healthy state. They begin to participate in breathing only if it is difficult. Auxiliary muscles include the wings of the nose, abdominal muscles, intercostal muscles, and muscles in the clavicle.
  • Inspiratory shortness of breath – difficulty breathing.
  • False croup is edema of the mucous membrane below the vocal cords, of viral or bacterial-viral origin.
  • The younger the child, the harder the disease is. Of course, exceptions are possible. The emergence of laryngeal edema contribute to the peculiarities of the child’s body. The vocal fissure in children is narrow, its muscles easily tire (even after a scream), the vocal cords and mucous membrane are gentle, their blood supply is very good, which determines the tendency to edema and the occurrence of stenosis (narrowing) of the larynx.

    False croup is also described in infants and children of the older age group. Laryngeal edema can be both the first manifestation of the disease, and the “gift” on the “tail” of the underlying disease. This condition can occur on the background of any body temperature. The attack, as a rule, arises at night in the morning. Perhaps the recurrence of the attack after treatment. There are children who accompany every infection with asthma attacks. Most often false cereal can be expected from children with allergies.

    The disease is usually caused by viruses, and develops gradually over several days.

    False croup: how to suspect?

    False croup develops most often suddenly, at night. The child may go to bed apparently healthy, and at night he will suddenly wake up excited, with bouts of loud “barking” cough.

    In addition, there is hoarseness, difficulty breathing. Already at a distance, a whistling difficulty in breathing is heard, which, in turn, causes tension in the auxiliary respiratory muscles, swelling of the nostrils, and tension in the muscles of the child’s neck.

    The skin, during an attack of suffocation, acquire a bluish tint, the heart rate increases

    Signs of mild edema mainly appear with shouting and anxiety. There is a “barking” cough, prolonged noisy inhalation, without the participation of auxiliary muscles. At rest, shortness of breath diminishes, but loud breathing persists.

    With a moderate degree of manifestation of false croup in a child, the above symptoms complement the noticeable arousal, sweating, and marble pattern of the skin. The auxiliary muscles take part in the act of breathing (swelling of the wings of the nose, tension of the neck muscles takes place).

    When the glottis becomes even already, the so-called decompensated stenosis. child’s condition is severe. Inhale at rest noisy, elongated, difficult. The skin is pale with an earthy shade, covered with cold sweat, resistant bluish color of the tip of the nose, lips, fingers. Excitement gives way to lethargy, occasionally the baby shudders. In very severe cases, loss of consciousness and respiratory failure.

    ATTENTION! If your child has an attack of “barking” cough and shortness of breath, call the doctor immediately.

    Emergency first aid for stenosis:

    1. Try to calm the child by removing unnecessary people from the room. Grandmothers ohlanie only scare the baby, and it will be easier for you when you are left alone with the child.

    2. While you are engaged in the baby, let someone be engaged in the ambulance call.

    (Be sure to call the Ambulance Team for any degree of stenosis. Only a doctor can say for sure that your child has a false croup, not an asthma attack, pneumonia or a foreign body in the airways.)

    3. Allow the child to breathe as cool, if possible, humidified air. Be sure to ventilate the room where the child is. Cold air reduces swelling of the mucous membranes. To do this, wrap the baby and you can go to the window or go to the balcony, breathe in the open window. In the summer, you can open the freezer door and try to take a few breaths there. Remember, without fanaticism, sharply cold air when moving a child from a knowingly warm room to a very cold one can, on the contrary, cause reflex of the larynx (narrowing of the respiratory tract) and aggravate the course of the disease.

    4. Be sure to give your child any allergy medication available at home: suprastin, phencarol, diphenhydramine. In an emergency, you can give the child a whole pill, regardless of age. Give the floor pills – worse not

    5. If there is an inhaler (nebulizer) in the house, it is possible to carry out inhalation with a 0.05% naphthyzine solution lasting up to 5 minutes.

    To prepare an inhalation solution, the drug should be diluted with a 0.05% saline solution in a ratio of 1: 5 (5 ml of saline per 1 ml of the drug) or diluted with a 0.1% drug in a ratio of 1:10 (10 ml of 1 ml of the preparation saline).

    To remove the edema, inhale once with 3 ml of the resulting solution, if necessary, the procedure

    6. Do not force your child to bed rest. The child himself knows what position of the body at the moment will make it possible to ease breathing.

    7. Give a warm alkaline drink. This may be milk or mineral water. In the milk, you can add baking soda at the tip of a knife. It is better not to give hot drink because it causes additional swelling of the soft tissues of the throat and irritates the mucous membrane. The optimum fluid temperature is that which is pleasant to the child. Children themselves feel the need to drink and, as a rule, do not refuse. It is better to give the liquid in small portions in 5−10 minutes. A large amount of alcohol can cause vomiting at the height of a coughing fit.

    In any case, even if you managed to remove the attack of false croup yourself, do not leave the child without supervision of the doctor, call the district doctor. If you are offered hospitalization – do not refuse. Or you can yourself boldly insist on hospitalization for observation. Often, bouts of false croup tend to recur for short periods of time.

    Prevention of false cereals:

    In the room where the sick baby is, the air must be warm, fresh, moist, but not damp.

    Be sure to give your child antihistamine (antiallergic) drugs at a time when he is sick. This will help if not avoided, then reduce the risk of and the severity of the attack of false croup.

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