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 ai rway 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 o f these children (10%), median age 14 months (range 10-36) and median weigh t 10 kg (range 6-12). Twenty seven of the children who underwent microlaryn goscopy (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 u lcerative gingivostomatitis. One of the 15 children did not require airway intervention. Nine children required nasotracheal intubation for a median o f 4 days (range 3-11) and median PICU stay of 6 days (range 4-14). Five chi ldren 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 t han the few reports suggest. Early diagnostic microlaryngoscopy is recommen ded in children with severe croup who follow an atypical course.