Severe upper airway obstruction caused by ulcerative laryngitis

AIMS To present our experience of severe upper airway obstruction caused by ulcerative laryngitis in children. METHODS Retrospective case note review of 263 children with severe upper airway obstruction and a clinical diagnosis of croup admitted to a paediatric intensive care unit (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 underwent microlaryngoscopy (18%) also had ulcerative gingivostomatitis consistent with herpes simplex virus infection. Ulcerative laryngitis was documented in nine of 27 (33%) children with, and in six of 121 (5%) children without, coexistent ulcerative gingivostomatitis. One of the 15 children did not require airway intervention. Nine children required nasotracheal intubation for a median of 4 days (range 3–11) and median PICU stay of 6 days (range 4–14). Five children required tracheostomy ab initio, with a median PICU stay of 30 days (range 20–36), and duration of tracheostomy in situ for a median of 19 days (range 15–253). All 15 children survived. CONCLUSION Ulcerative laryngitis is more common in our patient population than the few reports suggest. Early diagnostic microlaryngoscopy is recommended in children with severe croup who follow an atypical course.