Healthy Living

Laryngitis: What Is Croup?

Laryngitis: What Is Croup?

What is laryngitis?

Laryngitis is the swelling of your voice box. It is often caused by an infection, mostly by a virus. The voice box is also known as the larynx. It links the back of your throat to the windpipe. The vocal cord and larynx are part and parcel and are required for speech. Laryngitis generally results in a husky or hoarse voice that does not last long.    

What is croup?

Croup is a condition in children that affects the trachea or windpipe, which is the passage to the lungs or bronchi, and the larynx or voice box. In this condition, the voice of the child may change and become hoarse, and since the airway is clogged, the child will have trouble breathing. Other viruses can cause croup, including those that cause the common cold and influenza.

Sometimes, it is caused by bacterial infection, but only in rare cases. Croup is most common in children between the ages of 6 months to 3 years old. It will rarely occur in children who are 6 years old and above. It is most common during the late fall and all through the early winter. It slightly affects more boys when compared to girls. Treatment depends on whether it was caused by a virus or bacteria. 

How is croup diagnosed?

Croup is usually detected during a physical examination. The doctor will observe breathing patterns and a description of the symptoms or listen to the patient's cough.

A croup cough sounds similar to a harsh croaking noise. Prolonged symptoms may need an X-ray to eliminate other possible infections.

How long is croup contagious?

A person infected with croup will infect other members of the family, especially young children and infants. Older siblings and parents can develop a sore throat, but may not develop a much severe cough and stridor compared to children.

After some weeks, the person will not be considered contagious anymore, even though he or she continues to cough.

How is croup spread?

Croup is mostly caused by the parainfluenza virus. It is mostly spread through:

  • Contact with someone who is infected
  • Touching something that was already touched by somebody who is infected
  • Contacting the virus through the air from a cough by someone infected

Symptoms of Croup

Croup is easily recognized in children. The main symptom is a barking cough, and it can frighten you to hear such a cough coming from a child. Other symptoms might include: 

The symptoms are more serious during the night. The child will be awake, coughing, and frightened.

Cause of Croup in Adults

Adult croup is a viral infection caused by the parainfluenza virus. The virus is coughed or sneezed into the air, and simply inhaling these particles can cause infection. The virus is still active and viable even as it comes into contact with inanimate surfaces.

Croup Symptoms in Adults

Croup is generally seen as a children’s disease, which leads to difficulty in breathing. However, a person of any age can become infected. Infections mostly occur in autumn and winter, with reported chances of infection rising by 15 percent in a household.

Some of the profound symptoms of croup in adults include:

  • Upper respiratory infection
  • Fever
  • Rhinorrhea
  • Mild croup cough

As the disease progresses, inflammation also develops. Erythema and exudate are triggered due to the release of inflammatory factors, causing a cough with stridor. A hoarse voice may be produced as the vocal cords swell. Croup in adults is seen to worsen at night and can sometimes require a visit to the doctor.

Croup Treatment in Adults

Croup can develop from mild to severe. Sometimes, it may require medical attention. Remaining calm is vital, as panicking may aggravate the symptoms. Using steam or a vaporizer may be recommended as a remedy for the cough and congestion. If you suspect that you have the symptoms of croup, see a doctor immediately.

Warning Signs Parents Should Look Out For

Croup has been found to mostly affect young children. Major concerns arise if normal breathing is interrupted since it can quickly develop into a life-threatening situation if ignored. Constant monitoring should be done, and the doctor must be immediately notified if the child is suffering from prolonged difficulty breathing, increased slobbering, anxiety and nervousness, fever, or if the child feels frightened.

On some occasions, breathing is rapid and can become hazardous, requiring emergency medical services. Occasionally, children who develop severe symptoms require ambulatory services. Extreme caution should be taken with the following symptoms:

  • Uncontrolled drooling
  • Swallowing problems
  • Cyanosis or the bluish discoloration of the skin, especially the lips 
  • Sucking in of the chest
  • Rapid breathing (over 60 breaths per minute)

Facts About Croup

  • Croup is a respiratory ailment. As the disease develops, the trachea gets inflamed, narrowing the air entry space to the lungs.
  • During the first couple of days of the illness, croup is highly contagious.
  • The major symptom of croup is a cough with the sound of a barking seal.
  • Croup can be treated using moist and cool air, saltwater nose droplets, fluids, and medicine for fever and pain. A single dose of dexamethasone, an anti-inflammatory drug, can sometimes be prescribed by a pediatrician.  
  • Breathing difficulty while having croup, especially as the airways narrow, is a major distress. 
  • During the night, it is advisable to closely monitor the child's breathing.

Croup Treatment

The doctor can administer a dose of steroid to reduce the inflammation in the child's airways. If the right dose is given, the child will be safe. The doctor will also give you some home remedies to relieve the symptoms and help your child feel comfortable. A doctor might tell you to:

  • Give your child extra water and milk to avoid dehydration. If the baby has started eating, some warm soup or juice will taste good, especially if they have a low appetite.   
  • Give your child ibuprofen or infant paracetamol (liquid) if your baby has a fever and is in pain. It will help your baby feel more comfortable.

The baby can be given infant paracetamol if he or she is above 2 months old. If the baby is more than 37 weeks old and weighs nine pounds or more, you can administer ibuprofen or paracetamol. Read on the dosage instruction or consult your doctor if in doubt. 

  • The less the baby cries, the less the cough. Help the baby get comfortable and relaxed by sitting and holding him or her in an upright position just over your shoulder. The baby will breathe easily from that position.
  • Although there is no scientific evidence supporting the use of steam inhalation to relieve croup symptoms, some parents will use steam in a closed room, but be very careful not to scald the baby.
  • Never give the baby decongestants as they do not treat croup-related coughs.

Home Remedies

  • Stay hydrated: Drinking plenty of fluids when ravaged with croup is essential. Water and breast milk work as the best hydrants for infants. However, for older children, soups, or bone broth will also help. You can also try taking some herbal tea, lemonade, ginger ale, vegetable broth, or fruit pulp to increase body fluid and prevent dehydration as well as loosen mucus.
  • Take a hot steamy shower: Let hot water in the shower run while steam develops. Sit with your child for about 20 minutes while inhaling the steam to relieve the breathing pipe.
  • Use a cool mist humidifier: If steam does not help, use a vaporizer in your child’s room to add more moisture. Use a cool mist vaporizer in cold temperatures to ease congestion and coughing. A warm mist humidifier, although effective in humidifying a room, should not be used for infants since it can potentially cause more danger to them. In the absence of a cool mist humidifier, hang damp sheets in the room after checking with your doctor.
  • Inhale cool air: Try to keep the windows in your child’s room open to allow entry of fresh air. If driving at night, offer to keep the windows rolled down or go for a nighttime walk if possible. Moisture in the air will relieve labored breathing.
  • Keep an upright posture: Since breathing is difficult, sitting in an upright manner will ease the process. Infants cannot sit up by their own means and parents should make an effort to hold or support them in this position to help them breathe.
  • Have some honey: Honey is a natural cough suppressant. It can be used to reduce coughing during sleep and also to induce sleep. Give your child one teaspoon to ease the cough, but do not give it to children below 1 year old since there is a risk of poisoning caused by a toxin from anaerobic bacteria.
  • Drink lemon tea: Include ginger and honey (optional) when preparing lemon tea. Lemon tea invigorates the immune system and is also effective in managing throat pain.
  • Have an ice pop: Children with dry mouth and cough can be given popsicles since they tend to soothe a sore throat as well as keep the mouth watery.
  • Acupressure: Applying physical pressure at acupoints is said to relieve pain associated with many conditions. Pressing the wrist with your thumb has been found to be helpful. You can also press the last line on the ring finger while progressing toward the tip and lift. Repeat the same process for 100-300 times to help alleviate the pain.
  • Mustard: Make a paste with ¼ cup corn flour, one teaspoon mustard powder, and warm olive oil in a container. Spread this paste on a handkerchief and fold, ensuring it does not spill over. Use this mustard plaster at night, around the neck of your child, to relieve pain from croup.
  • Castor oil: Castor oil is easily absorbed through the skin, and a warm compress placed on the chest will aid in opening the airways of the child. Since it has anti-inflammatory effects, castor oil is recommended as a remedy for croup patients.

Fever Treatment

Do not overdress the child, and avoid blankets as well as duvets. Applying a soft, wet towel on the forehead will help. Maintain an appropriate room temperature, preferably not exceeding 66-68 degrees Fahrenheit.

Keep the baby hydrated by giving him or her small sips of water after every 10 minutes or so. You can give the baby ibuprofen or paracetamol according to age. Avoid distressing the baby to your best ability.

The baby should not be given medicine without a doctor’s advice. Visit a doctor if fever persists and if any other symptoms such as vomiting, stomach pain, or diarrhea occur.

Treatment for Chronic Laryngitis

In older children and adults, croup is sometimes referred to as chronic laryngitis. It happens when the vocal cords become inflamed or infected. If symptoms result from an infection in the respiratory tract, you will be required to see a doctor for immediate assessment and treatment.

The most commonly used treatment methods for chronic laryngitis include:

  • Getting enough rest: It is imperative to rest your vocal cords. For example, singers should limit their singing time to allow the inflammation to heal. For faster healing, getting adequate rest and reducing the time in which the voice is used should be followed by all, even if singing is not your profession.
  • Keeping hydrated: Drink enough fluids or keep your throat hydrated by sucking on lozenges. Your doctor can also advise you to use humidifiers to keep your room moist to soothe your throat and ease congestion. Avoid caffeine and alcohol since they can worsen the inflammation.
  • Taking medications: Your doctor will prescribe some antibiotics if bacteria is the cause of laryngitis. Viruses can also cause infectious laryngitis. Treatment will vary depending on the cause and you can be given decongestants, pain relievers, or steroid injections.
  • Surgery: If your condition is caused by vocal cord polyps and paralyzed vocal cords, it may be considered severe, and your doctor may recommend surgery. 

Risk Factors for Chronic Laryngitis

  • Tobacco smokers and those who are repeatedly exposed to harmful fumes
  • Those who have upper respiratory diseases
  • If you have ulcerations or growths on vocal cords when used repeatedly

The Origin of Severe Croup

Severe croup is caused by viruses transmitted through inhaling cough droplets or direct contamination after coming into contact with the nose, mouth, and eyes. Parainfluenza viruses types 1, 2, and 3 are notorious for causing annual croup epidemics.

The common entry routes are the nose and mouth. The infection will spread and ultimately affects the larynx and trachea. If the lower respiratory tract is involved, as in laryngeal-tracheal-bronchitis, further diagnosis is done to assess if there is a secondary bacterial infection.

The larynx and trachea below the glottis may be inflamed and edema kicks in, particularly around the ring-shaped cartilage. Histologically, the area is dropsical with cellular incursion located in the lamina membrane, submucosa, and adventitia. The infiltrate contains erythrocytes and plasma cells.

The parainfluenza virus activates chloride secretion and restricts sodium intake across tracheal epithelium, promoting airway edema. The functional area most affected is the slimmest part of the airway, where swelling can considerably limit airflow. This results in stridor, strained breathing, and chest wall retraction. There can also be endothelial damage and ciliary malfunction. A mucoid fibrinous secretion clumps the lumen of the trachea. Diminished mobility of vocal cords caused by edema results in a coarse bark-like cough.

In severe diseases, fibrin-rich exudates and pseudomembranes may emanate, causing hazardous airway blockage. A deficiency of oxygen in the blood may occur from the gradual narrowing of the lumen and abnormal alveolar ventilation and ventilation-perfusion misalliance.

Spasmodic croup is similar, but it is absent of fever and inflamed mucosal membranes. It occurs at night and is an indication of recurrent croup in babies and children. Subglottic edema occurs without inflammation, although it can be triggered by a viral disease. However, the reactions may be of allergic but not infectious in origin.

Is croup associated with any complications?

It is very rare for croup to cause complications. The only serious thing it can cause is difficulty in breathing. If the symptoms become severe, call for emergency help. Visit your local hospital if the baby:  

  • Struggles more and more to take every breath
  • Is having problems inhaling and the baby’s low tone stridor changes to a whistle-like sound
  • Cannot cry or talk 
  • Starts to become pale
  • Starts to drool excessively and swallowing gets difficult
  • Increasing inhalation but the breathing sound is fading
  • Seems sluggish or very sleepy all of a sudden
  • Looks like the neck and rib cage are drawing in

On hospital arrival, oxygen will be given to the baby to assist his or her breathing. Steroids can be orally administered or inhaled to minimize airway inflammation.

The Prevalence of Croup

Worldwide, croup accounts for 15 percent of childhood acute stridor emergencies. It mostly occurs in infants between 6-36 months. In North America, it is more common after the first year of life, at about 1 case in 16 infants, but becomes uncommon after 6 years old with rare occurrences afterward. The male to female ratio is estimated at 1.4:1.

Croup is more common in late autumn and early winter than any other time. Five percent of children will be reinfected at some point in their childhood.

How long does croup last?

Croup goes away in many children after 3 to 7 days. Sometimes, it can last for one week. Make sure you continue with home treatment during this period to reduce the symptoms. Once you get used to the nasty cough, it will continue for a while, and then toned-down, leaving the baby a bit exhausted, but well.

After Croup Treatment

Viral croup usually vanishes after a week or so. Although bacterial croup can be dangerous, a course of antibiotic treatment is given depending on its severity. If dangerous symptoms develop, it is vital to seek immediate medical attention and treatment.

Prognosis and Outlook

The prognosis is excellent with an almost assured total recovery. Since it is rarely severe, many casualties can be handled as outpatient cases. During the 1990s, annual hospitalizations averaged at 41,000, but currently, the number is considerably lower. There are also a declining number of infants requiring intubation.

Currently, the use of anabolic steroids and nebulized adrenaline for treatment, frustrate the need for intubation, at a prevalence of below 0.5 percent.

Recent evidence suggests that hospitalization may be due to imminent development of asthma. Children hospitalized with croup have been found to have higher levels of bronchial hyperresponsiveness and sensitivity to skin testing.  Other factors that aid the development of asthma are recurrent croup, family asthma history, and exposure to smoke.

Is croup preventable?

Currently, there is no vaccine for croup. Croup is mostly transmitted by coughing, sneezing, or contact with infected surfaces. Airborne viruses are potent for up to an hour, but if their presence is on an object, their lifespan is considerably extended.

Frequent handwashing and avoiding contact with infected people will help prevent getting infected croup.

What happens if croup goes untreated?

It is rare for croup to develop into a severe condition, which requires hospitalization or steroid medication. Croup can be handled at home by ensuring there is a steady flow of cool and moist fresh air.

Preparing for Your Appointment

Appointments are usually done after the symptoms persist or there is no positive feedback from medications.

The doctor may ask detailed questions, which generally relate to the symptoms and source of infection, how long the infection has carried on, any previous history of croup infections, any medications taken, vaccinations, or if there is any noticeable pattern of coughing that has developed.

Maintaining Healthy Vocal Cords

If you want to keep your voice box and vocal cords healthy, make sure they are always moist and away from irritants. Below are some ways to avoid irritants:

  • Stop smoking or stay away from people who smoke
  • Reduce alcohol and caffeine consumption
  • Always wash your hands to avoid getting colds or upper respiratory infections
  • Keep away from toxic chemicals at work, whenever possible
  • Use a pillow to raise your head while sleeping to protect your larynx against acid reflux 
  • Avoid shouting or singing for longer durations
  • Refrain from clearing your throat as it increases mucus production and causes irritation