Severe upper airway obstruction caused by ulcerative laryngitis

AIMS—To present our experience ofsevere upper airway obstruction caused by ulcerative laryngitis in children.
METHODS—Retrospective case notereview of 263 children with severe upper airway obstruction and aclinical diagnosis of croup admitted to a paediatric intensive careunit (PICU) over a five year period.
RESULTS—A total of 148 children(56%) underwent microlaryngoscopy (Storz 3.0 rigid telescope).Laryngeal ulceration with oedema was documented in 15 of these children(10%), median age 14 months (range 10-36) and median weight 10 kg(range 6-12). Twenty seven of the children who underwentmicrolaryngoscopy (18%) also had ulcerative gingivostomatitisconsistent with herpes simplex virus infection. Ulcerative laryngitiswas documented in nine of 27(33%) children with, and in six of 121 (5%) children without, coexistent ulcerative gingivostomatitis. One ofthe 15 children did not require airway intervention. Nine childrenrequired nasotracheal intubation for a median of 4 days (range 3-11)and median PICU stay of 6 days (range 4-14). Five children requiredtracheostomy ab initio, with a median PICU stay of 30 days (range20-36), and duration of tracheostomy in situ for a median of 19 days(range 15-253). All 15 children survived.
CONCLUSION—Ulcerative laryngitis ismore common in our patient population than the few reports suggest.Early diagnostic microlaryngoscopy is recommended in children withsevere croup who follow an atypical course.