Definition

The larynx is a passage that connects the throat with the respiratory system. It facilitates various functions within the respiratory system, allowing air to pass from the throat to the trachea and into the lungs. Composed of cartilage providing its structure and muscle tissue aiding in swallowing, breathing, and sound production, the larynx plays several vital roles in the body. These include serving as an air passage for respiration, protecting the vocal cords, and reducing the risk of choking. Additionally, it can detect foreign particles such as viruses, bacteria, or debris entering the respiratory tract and causing infections.

When foreign particles enter the larynx, they trigger a response in the form of coughing to expel the object. The larynx also functions as the voice box, containing vocal cords that vibrate to produce sound for speaking, singing, and shouting. Furthermore, the larynx prevents choking through the presence of the epiglottis. This valve-like structure serves as the entrance to the larynx during swallowing, only opening when we swallow to prevent food or liquid from entering the pharynx and causing choking.

Edema is a condition characterized by an excess of fluid volume in the body. Laryngeal edema specifically refers to swelling resulting from an accumulation of excessive fluid in the laryngeal area. This swelling can be caused by inflammatory processes, whether infection or general inflammation. While laryngeal edema is rare, it can be a complication of other diseases. Close monitoring of this condition is essential as it can lead to a medical emergency.

Causes

Laryngeal edema commonly occurs at night, especially in children, and can be caused by toxins produced by streptococcus bacteria. Besides bacterial infections, laryngeal edema may also result from common diseases affecting the immune system, such as diabetes, uremia, vitamin deficiencies, cachexia, or infections like influenza and dengue fever. Additionally, injuries or trauma to the larynx and respiratory disturbances are among the causes of laryngeal edema. 

One common type of trauma that often leads to laryngeal edema is after the removal of a breathing tube in hospitalized patients. Typically, laryngeal edema appears within 30 to 60 minutes after extubation (removal of the tube inserted into the throat), although it may sometimes manifest as late as 6 hours after tube removal.

Risk factor

Some risk factors can increase the risk of laryngeal edema, including being female and belonging to the childhood to adolescent age groups. Certain medical conditions, such as long-term intubation (tube insertion) and therapies like a history of radiotherapy to the head and neck area, also elevate the risk of experiencing laryngeal edema.

Symptoms

The most common symptom of laryngeal edema is airway obstruction. This condition may also be accompanied by an increase in body temperature and a significant decrease in voice function. 

Clinical symptoms of laryngeal edema include difficulty swallowing (dysphagia), a sensation of a lump or obstruction in the throat, throat tightness, changes in voice, including hoarseness and roughness, and difficulty breathing. In patients with advanced laryngeal edema, they may also experience severe shortness of breath and even loss of voice.

Diagnosis

Doctors will conduct examinations based on the symptoms you experience and your medical history. Diagnosing laryngeal edema in children is usually more challenging than in adults due to difficulties in physical examination and other factors contributing to laryngeal edema in children. Parents of children with laryngeal edema can provide valuable information to the doctor. 

Direct laryngoscopy and ultrasonography are some tests that the doctor may recommend to support the diagnosis of laryngeal edema. Direct laryngoscopy is performed to assess diseases inside and around the larynx, while ultrasonography is used to detect abnormalities in the shape of the larynx or tumors.

Management

Treatment for laryngeal edema depends on the severity of the symptoms experienced. Mild cases may be managed with home care measures such as swallowing small pieces of ice and applying ice packs to the neck area. However, in severe cases or if the symptoms are serious, the doctor may prescribe various treatments such as antihistamines, anti-inflammatory drugs, and other supportive medications. 

If laryngeal edema is caused by common illnesses or poisoning, the doctor will conduct examinations and provide treatment for the underlying disease and measures to relieve laryngeal edema. In cases where infection is suspected, intensive antibiotics may be prescribed.

It is crucial to note that laryngeal edema can develop rapidly, leading to acute respiratory distress that is life-threatening and requires immediate action. In such situations, the final intervention may be intubation to assist breathing. Intubation involves the insertion of a tube through the patient's nose or mouth and down into the trachea. This tube helps keep the trachea open so air can enter and may be connected to a machine that delivers air or oxygen. 

Additionally, therapy for laryngeal edema may include humidified oxygen delivery, epinephrine nebulization, maintaining an elevated head position, and, in certain cases, re-intubation with a smaller tube (Endotracheal tube) if the condition improves. Overall, the management of laryngeal edema depends on the severity and condition of the patient.

Complications

Laryngeal edema can lead to complications if left untreated and can be fatal due to associated respiratory disturbances, such as difficulty breathing and shortness of breath. The intubation process, which can cause laryngeal edema, may also result in infection. In the worst-case scenario, laryngeal edema following extubation can lead to respiratory failure, necessitating re-intubation.

Prevention

Laryngeal edema can occur using breathing tubes, especially in critically ill patients. While there is a high risk of laryngeal edema with the insertion of breathing tubes, the benefits and drawbacks of tube use must be carefully considered. 

Doctors may initially administer antibiotics to prevent tube-related infections. According to some studies, the use of corticosteroids has demonstrated a reduction in the incidence of laryngeal edema. Steroid infusion prevents or reduces edema after long-term ventilation (>36 hours). This therapy has shown beneficial effects, particularly in adult patients.

When to see a doctor?

Contact your doctor if you experience symptoms of laryngeal edema. If your doctor performs intubation, discuss the safety and risks of the procedure with them. Seek medical attention immediately if you feel shortness of breath, difficulty breathing, or discomfort such as choking sensations in the upper throat.

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