32. Acute laryngitis in the ED
Doctor: Good night Madam. I’m Dr. Taylor. What brings you here?
Mother: I’ve brought Harry because he’s been coughing for the last 2 days, but tonight the cough is different and he seems to have trouble breathing.
Doctor: How old is Harry? Does he have any past medical history? Other illnesses, surgeries or hospitalisations? Does he have any other symptoms like fever or hoarseness?
Mother: Harry is 3 years old and he doesn’t have any relevant past medical history. He started with cough and a runny nose 2 days ago, fever since yesterday and hoarseness today. He doesn’t have any other symptoms.
Doctor: Alright, let’s take a look at Harry.
Pulse: 100 bpm. Mild tachypnea (30 bpm). SpO2: 98%. Axillary temperature: 37ºC. Good general condition. Well-nourished and hydrated. Normal colour, no cyanosis. Capillary refill time: 2 seconds. No respiratory distress. Barking cough without audible stridor. Dysphonia. Cardiac auscultation: regular, no heart murmur. Pulmonary auscultation: general good bilateral ventilation, mild inspiratory stridor. HEENT: mildly hyperemic oropharynx, mucus in cavum. Normal tympanic membranes. Small inflammatory cervical lymphadenopathies. Abdomen: soft, nontender to palpation. No liver edge or spleen felt. No masses. Neurological: alert and oriented in all 3 spheres. Westley score: 1 point.
Doctor: Very well Harry. Madam, it seems your son has mild acute laryngitis. Laryngitis is the inflammation of the vocal cords, which usually causes the voice to sound hoarse and a typical barking cough. Given he has a runny nose and fever; the most probable cause is a viral infection affecting his throat.
Mother: Does he need any tests?
Doctor: For the moment, he doesn’t need any tests, the physical examination is enough.
Mother: And what is the treatment?
Doctor: The treatment consists in oral steroids as anti-inflammatory therapy, in this case single-dose dexamethasone. He can also take acetaminophen for the fever.
Mother: Is there anything else I can do for him?
Doctor: Exposure to cold night air and the use of a humidifier producing mist at room temperature might lessen the symptoms. If you don’t have a humidifier, you can seat with the child in the bathroom filled with steam after a bath or shower. Keeping the child’s head elevated while sleeping may also help. You should also encourage him to drink water frequently and avoid crying as possible, as it can worsen the inflammation. Smoking at home should also be avoided.
Mother: OK. When should I worry?
Doctor: You should come back for a new evaluation if he presents difficulty breathing such as retractions (sucking in of the skin around the ribs and the top of the sternum) or inability to speak or cry, or a whistling sound with breathing, or a high-pitched, noisy breathing while resting, referred to as stridor, or looks pale, or has drooling or difficulty swallowing. If the child becomes severely agitated, blueish, excessively drowsy or frankly struggles to breathe, you should call 112. But don’t worry, he will most likely improve with the treatment.
Mother: When will he get better?
Doctor: He will improve in 3 to 5 days. If his fever lasts more than 3 days or the other symptoms last longer than 7 days, you should visit your reference pediatrician.
Barking cough: tos perruna (to bark: ladrar).
Inspiratory stridor: estridor inspiratorio.
Alert and oriented in all 3 spheres: consciente y orientado en las 3 esferas.
Vocal cords: cuerdas vocales.
Single-dose: dosis única.
Exposure to cold night air: exposición al aire frío de la noche.
Room temperature: temperatura ambiente.
Lessen (to): disminuir.
Sucking in: hundimiento.
Whistling sound: sonido silbante (pitos/sibilancias).
Resting: en reposo.
Difficulty swallowing: dificultad para tragar.
Struggle to breathe: tener dificultad para respirar.
Reference pediatrician: pediatra de referencia.