Can Laryngitis Lead To Death?
Clinically, adult epiglottitis is different from the child, since in adults the symptoms onset is less acute and the pathology is usually preceded by an upper respiratory tract infection. It is manifested by the appearance, in the context of fever and malaise, of low intensity odynophagia (sore throat) that increases suddenly, until it is impossible to swallow the secretions themselves, muffled voice and inspiratory stridor. Inspiratory dyspnea does not occur in all cases but is presented as a sign of gravity. However, in the child the debut with dyspnea and stridor is more frequent, and its onset with odynophagia is rarer, and it also has a higher complication rate.
With regard to clinical examination, although in children the risk of aggravating respiratory compromise must be taken into account by pharyngolaryngeal inspection maneuvers, which is why they are usually contraindicated in adults, in general, it must be performed indirect laryngoscopy and/or fibrolaryngoscopy, to observe the affected area and the degree of laryngeal obstruction. The examination in the case of the adult can show from erythema or edema, whether mild or moderate, to the classic signs such as cherry red epiglottis, and “bell pendant” shape. Sometimes it can be located above the base of the tongue, due to the great edema that it presents, in addition it can be accompanied by swelling of arytenoids, arytenoepiglottic folds and even the posterior wall of the pharynx, and while in the child the findings are almost always those of swelling of the epiglottis without other accompanying signs.
Epiglottitis is an acute condition susceptible to serious or even fatal complication, so the patient must be closely monitored. Most experts argue that the correct treatment in adults and in the absence of airway compromise consists of hospital admission and early administration of broad spectrum antibiotics intravenously, antibiotic treatment should begin as soon as possible, in high doses, and if possible adapted to the antibiogram. H. influenzae type B has shown variable resistance to Ampicillin and Amoxicillin-clavulanic acid, which is why second and third generation cephalosporins are nowadays more commonly used, associated with an aminoglycoside and eventually metronidazole. In cases of allergic to penicillin, Aztreonam and Chloramphenicol are used. The antibiotic treatment is always associated, and especially if there is an important edema, to an intravenous and/or aerosol corticoids treatment, in case of suppuration the corticotherapy is more discussed.
Each aerosol can be composed of: a 1 mg ampulla of adrenaline, a dexamethasone ampoule, a Bromhexine ampoule and a Framycetin ampoule.
Analgesics and rehydration must not be forgotten. The patient will be fasting until the clinical signs improve. The feeding will restart when there is good local and general evolution.
In adults, airway control by intubation is indicated only when signs of respiratory severity appear, and it is initiated earlier when there is dyspnea (respiratory distress). In case of not being able to proceed to intubation in respiratory emergencies, a tracheotomy is performed under local anesthesia. Some experts defend this second option for the control of the airway instead of orotracheal intubation, considering it safer.
In general, the evolution is good with intravenous treatment in a period of 24-48 hours, and no other technique is necessary, but there is always the real possibility of having to secure the airway.
The prognosis depends on the rapidity of the signs and early treatment. Currently, mortality is less than 1% and the need for intubation or tracheotomy has percentages of between 10% and 25%, except in cases of immunosuppression.
The Main Complications of Epiglottitis Are:
- Obstruction of the airway, whose treatment would be orotracheal intubation or tracheotomy.
- The epiglottic abscess.
The prognosis for acute laryngitis is favorable. Stenotic laryngitis is also favorable for early treatment. With late-onset treatment, especially in the terminal stage, a lethal outcome is possible. That is why is so important to be aware of the symptoms and attend to the healthcare professionals as soon as possible.
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