Diagnosis of laryngeal dyspnoea

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I- INTRODUCTION :

Dyspnea is defined as a "difficulty breathing". It is a therapeutic emergency because it can be the cause of hypoxia that can be life-threatening and neurological.

II- ANATOMY :


III- POSITIVE DIAGNOSIS :

The diagnosis of laryngeal dyspnea is primarily clinical.

A- At the & rsquo; child :

1- The diagnosis is easy if the symptoms are typical, teaming up :

an inspiratory bradypnea

a draw : c & rsquo; is depression soft tissue linked to depression inspiratory airway underlying premise to the & rsquo; hurdle.
The draw can be suprasternal, their- clavicular, intercostal, epigastric.

Laryngeal inspiratory noise : s can & rsquo; act :
– oyster : c & rsquo; is an acute noise ratio with an obstacle glotto-supraglottic.
– de Cornage : c & rsquo; is a harsh noise reflecting an obstacle subglottic.

One can note changes of voice and cough.

2- Diagnosis is more difficult if the symptoms are atypical :

in the new-born :

Bradypnea may be replaced by an apnea, Access cyanosis, bradycardia or d & rsquo; cardiac arrest

among newborns and infants :

Bradypnea may be replaced by tachypnea.

Advanced laryngeal dyspnea may result in superficial polypnoea without drawing, which signs the & rsquo; depletion of & rsquo; child and should not believe in an improvement.

B- In adults :

Chronic laryngeal dyspnea, d’installation progressive, is more common than in the & rsquo; child, the larynx of & rsquo; adult wider than that of the child.

It s & rsquo; d & rsquo acts, with an inspiratory bradypnea draw supraclavicular and intercostal.

O & rsquo; it sounds combine laryngeal (stridor, cornage).

Other symptoms can coexist :

  • Cough
  • dysphonie
  • Dysphagie
  • odynophagie.

IV- DIAGNOSIS OF GRAVITY :

The severity criteria :

  • l & rsquo; age : plus & rsquo; child is young, less tolerance is good.
  • The duration of dyspnea : beyond d & rsquo; one hour, dyspnea gets serious.
  • Signs of & rsquo; hypercapnia : sweats, tachycardia, hypertension.
  • L & rsquo; irregular breathing : respiratory pauses, replacing the inspiratory bradypnea by superficial tachypnea with reduction or disappearance of the draw reflecting the & rsquo; exhaustion.
  • Signs of & rsquo; hypoxia : Late cyanosis is extremely serious.
  • L & rsquo; state of consciousness : somnolence.

V- DIFFERENTIAL DIAGNOSIS :

A- Dyspnea d & rsquo; cardiac :

it s & rsquo; d & rsquo acts; tachypnea of 2 respiratory time without pulling or wheezing or stridor.
The voice and coughing are normal.

B- asthmatic dyspnoea :

These are bradypnées with expiratory expiratory wheezing characteristic auscultation and pulmonary signs.

C- Dyspnea d & rsquo; origin tracheobronchial :

affect 2 time breathing and s & rsquo; & rsquo accompanied by; a "Wheezing" (whistling expiratory and / or inspiratory) and d & rsquo; cough.
The voice is normal.

D- Dyspnea obstructive supralaryngeal :

Give an inspiratory bradypnea but the draw is the highest located in region- mandibular.
s can & rsquo; act obstructive rhinitis, imperforation bilateral choanaie, Pierre Robin syndrome ( giossoptose, microrétrognathie, and palatine swallowing disorders division), retropharyngeal abscess.

E- Dyspnea d & rsquo; metabolic :

They are large and deep with slow breathing and pauses (dyspnea Kussmaui).

F- Dyspnea d & rsquo; neurological and muscular :

  • central : Dyspnea Cheyne-Stokes.
  • peripheral : poliomyelitis, poiyradiculonévrite, myasthénie.

G- Dyspnea d & rsquo; psychogenic :

WE- ETIOLOGICAL DIAGNOSIS :

A- At the & rsquo; child :

1- In newborns and infants under 6 month :

a- Malformations laryngées :

Webs or diaphragm laryngeal, stenoses subglottic, paralysis of the dilators, laryngeal cysts, diastema laryngeal.

b- Laryngeal stridor critical congenital or laryngomalacia :

it s & rsquo; is excessive laxity of laryngeal structures with suction laryngeal curbstone when & rsquo; inspiration.

c- Angioma subglottic :

  • The Réalise a tableau de laryngite aigue sous-glottique relapsing are premier épisode est avant unten 6 month with a free interval 3 weeks after birth.
  • The diagnosis is endoscopic. In almost half of cases, cutaneous hemangiomas are found.

d- Laryngeal paralysis unilateral or bilateral :

2- After the & rsquo; age 6 month :

a- Acute laryngitis :

1- laryngite sous-glottique :

  • The onset is gradual, often at night, sans prodrome, during or subsequent to an infectious episode nasopharyngeal.
  • Fever is moderate (38° 38.5 °).
  • Laryngeal dyspnea appears within hours, associated with a hoarse cough and a modified voice.
  • It s & rsquo; is usually a viral infection, occurring in small epidemics.

2- laryngo-tracheobronchitis :

  • it s & rsquo; d & rsquo acts; laryngeal impairment associated with tracheobronchial reached where Staphylococcus aureus is the most commonly involved.
  • clinically: include severe infectious-type high fever signs, chills, important asthenia.

Laryngeal dyspnea at first soon becomes mixed with at & rsquo; auscultation rhonchi to 2 lung fields.

3- laryngite striduleuse :

  • the s & rsquo; agit d & rsquo; a laryngite of brutal forces to scream rauque, happy night, during which appear short-term bouts of suffocation.
  • This type of laryngitis may usher measles.

4- laryngite sus-glottique ou épiglottite :

  • Most often due to Haemophilus influanzae, it causes micro-abscesses of & rsquo; epiglottis laryngeal edema with large vestibule.
  • C & rsquo; is a great therapeutic urgency for putting life threatening.
  • Plus rare que la laringitis sous-giottique, It most often affects the boy to the & rsquo; age 3 years.

The clinic is marked by :

  • sudden onset with high fever
  • severe dysphagia and laryngeal dyspnea d & rsquo; sudden onset.
  • L & rsquo; child is prostrated, blade, sitting and refuses to s & rsquo; lengthen. The voice is muffled and cough is clear.

L & rsquo; s emergency hospitalization & rsquo; imposes.

– foreign bodies

– trauma

  • External cervical trauma
  • burns from caustic liquid or boiling liquid
  • allergic edema or pitting d & rsquo; insect
  • traumatismes iatrogènes post-intubation

– tumors

→ laryngeal papillomatosis

  • dysphonia is the first sign and s & rsquo; gradually moved dyspnea.
  • The etiology is viral: papillomavirus.

The examination or fiberoptic laryngoscopy suspended shows tuft 0,5 mm, pedunculated or sessile, grayish or whitish or pinkish, located on the vocal cords or on the floor of the ventricles.

→ other benign or malignant tumors are exceptional.

B- In adults :

1- tumors :

a- malignancies :

– These are cancers of the larynx, and cancers of the & rsquo; hypopharynx
– They are seen in the & rsquo; man 45 at 70 years.
– Predisposing factors are :

  • tobacco laryngeal cancer
  • alcohol to the hypopharynx.

Functional dysphonia signs, dysphagia and dyspnea for cancers of the larynx.

– For cancers of the hypopharynx, Dysphagia is the first symptom.
– Diagnosis is based on the & rsquo; ENT examination associated with laryngoscopy under general anesthesia with biopsies suspension anapath review.

b- benign tumors : papillomatose laryngée, tumor Abrikossof, chondroma of the cricoid, laryngocèle…

2- Laryngeal dyspnea d & rsquo; the functional and neurological origin :

It s & rsquo; d & rsquo acts; conditions affecting the mobility of the vocal cords, they can be permanent or intermittent.

a- Laryngeal permanent dyspnoea :

– This is laryngeal paralysis closure, bilateral.
– The onset can be sudden realizing a painting asphyxia requiring intubation or tracheostomy d & rsquo; urgent but more often, it is progressive with a slight laryngeal dyspnea and well tolerated.
– The causes can be :

  • central : viral encephalitis, syphilis, amyotrophic lateral sclerosis, Chronic anterior poliomyelitis, multiple sclerosis…
  • peripheral devices : surgical trauma (thyroid surgery), axis tumors visceral neck…

b- Intermittent laryngeal dyspnoea :

laryngeal spasms :

– It s & rsquo; is intermittent episodes of excessive and inappropriate closure of the larynx, responsible breathlessness access without permanent dyspnoea.
– pathophysiology: it evokes an exaggeration of the laryngeal closure reflex:

  • or by increasing motor responses
  • either by lowering the trigger threshold of the reflex.

They are

  • primitive is occurring in response to a laryngeal irritation from gastroesophageal reflux, postnasal drip, a wrong, a cough, inhalation of foreign bodies or caustic
  • or during various neurological conditions : tabes, syringobulbie, Parkinson disease, epilepsy
  • they can also occur during tetanus or rabies.

3- Laryngeal dyspnea d & rsquo; infectious :

a- epiglottitis :

  • Rare in & rsquo; adult, c & rsquo; is the most severe form of acute laryngitis.
  • The main organism is Haemophilus influanzae.
  • L & rsquo; male involvement is preferentially.
  • In an infectious context, occurs pharyngeal pain.
  • Dysphagia is d & rsquo; sudden onset sometimes hypersalivation.
  • Laryngeal dyspnea is often delayed onset.

b- laryngite diphtérique ou croup laryngé :

– False characteristics membranes at véloamygdalien s & rsquo; extend to the larynx are the & rsquo; origin of obstruction.
– A levy should be practiced in search of the bacillus Klebs-Loeffler.

c- laryngite flu :

– There are serious and dyspnéisantes forms with edematous attacks epiglottidean, ulcerative and even phlegmonous.

d- laryngeal tuberculosis :

e- in the & rsquo; immunocompromised (aplasie, page) :

A banal acute laryngitis can take a formidable evolutionary aspect

4- Dyspnea laryngeal d & rsquo; inflammatory :

a- allergic laryngitis :

– The context is often suggestive of atopy known with the concept of & rsquo; a trigger (d & rsquo bite, insect, food or drug ingestion…).

b- angioedema :

– C & rsquo; is the angioneurotic edema classic.

c- laryngitis inhalation caustic vapors :

5- Laryngeal dyspnea d & rsquo; traumatic :

external trauma : Accident of the public highway, Attempts & rsquo; autolysis by hanging, sports injuries (combat sports).

Laryngeal dyspnea d & rsquo; traumatic :

external trauma : Accident of the public highway, Attempts & rsquo; autolysis by hanging, sports injuries (combat sports).

iatrogenic trauma : prolonged tracheal intubation, tracheotomy or association.

6- Laryngeal dyspnea inhaled foreign body :

– It is a rare accident in adults.

VII- TREATMENT :

Maneuver de Heimlich

Maneuver de Heimlich

Intubation / tracheotomy

Intubation / tracheotomy

VIII- CONCLUSION :

  • The diagnosis of & rsquo; laryngeal dyspnea requires above all the clinical recognition of the seat of laryngeal respiratory obstruction.
  • It is d & rsquo; in assessing the gravity. A good driving history and physical examination allow in many cases an etiological.
  • The treatment will involve the removal of dyspnea (corticosteroids, intubation, tracheotomy) and will then be adapted according to the & rsquo; etiology.
Larynx normal : inspiration / Larynx normal : phonation

Dr Loriam's Course – Faculty of Constantine