With diphtheria, stenosing laryngitis develops, which is called true croup. If the spasm of the larynx has developed against the background of other infectious diseases, then the croup is called false. Such a croup in otolaryngology is also called acute obstructive laryngitis, stenosing laryngitis, subglottic laryngitis or subglottic laryngitis.
False croup is more common in children under 6 years of age, which is associated with the small size of the larynx, its funnel-shaped shape and looser tissue in the subglottic region. These anatomical features contribute to the rapid development of inflammation and swelling of the larynx. How does false croup develop?
Causes and mechanisms of development of false croup
Viral infections are a common cause of false croup. These are influenza viruses, parainfluenza, adenoviruses, herpes simplex viruses, whooping cough, chicken pox, measles viruses. False croup, which develops against the background of bacterial processes, is rare and more severe. False croup can develop as a complication of chronic tonsillitis.
Some children are more likely to develop false croup with viral infections. These are children with birth trauma, the development of fetal hypoxia during childbirth, the development of diathesis, rickets, as well as against the background of artificial feeding and vitamin deficiency. False croup differs from the true one in that inflammatory processes in the larynx occur with the development of stenosis.
Mechanism of development of stenosis in false croup:
- The process of inflammation of the larynx is accompanied by a pronounced swelling of the space that is under the vocal cords. This significantly narrows the lumen of the larynx in this area.
- A reflex spasm of the constrictor muscles of the larynx appears, which further aggravates its stenosis.
- In inflammation, the secretory activity of the glands increases, thick mucus is formed in large quantities. All this obturates the lumen of the larynx even more.
What are the symptoms of false croup?
The mechanisms described above contribute to the development of an obstructive syndrome, in which the passage of air into the respiratory tract is disturbed. If at the beginning of the development of a false croup these phenomena are compensated with the help of increased work of the respiratory muscles, then with an increase in the degree of stenosis, the stage of decompensation begins.
Then hypoxia develops, leading to disruption of the cardiovascular system and central nervous system. As a rule, false croup develops on the 2nd-3rd day of an acute viral disease of the upper respiratory tract. Manifestations consist of a triad of signs of false croup:
- a clear loud cough with a barking tinge;
- stridor - noisy breathing, which is caused by narrowing of the lumen of the pharynx;
- hoarseness of voice.
At the same time, the patient has shortness of breath of an inspiratory nature. The child is restless. On examination, an increase in the lymph nodes of the cervical group is detected.
Stages of development of stenosis in false croup
The development of stenosis in false croup has 4 stages:
- 1 stage – shortness of breath appears during physical exertion or excitement of the child. The breath becomes lengthened.
- 2 degree – shortness of breath at rest. Additional muscles take part in breathing. When inhaling, the jugular fossae are retracted.
- 3 degree – barking cough and paradoxical breathing join all the symptoms. Shortness of breath of a mixed nature is an unfavorable sign of the development of the disease. Diffuse cyanosis appears, the child is lethargic and drowsy.
- 4 degree – the typical barking cough is absent. Breathing becomes superficial, non-rhythmic, bradycardia, hypotension, seizures are possible.
False croup is special in that changes in the severity of the condition occur very abruptly, the transition from stage 1 to stage 4 occurs within one day. Therefore, it is extremely important to identify false croup in time and provide medical assistance.
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