Healthy Living

Laryngitis: What is Croup?

Laryngitis: What is Croup?

Key Takeaways

  • Croup is mostly common in children between the ages of 6 months to 3 years
  • Symptoms are more serious during the night
  • Never give the baby decongestants as they never treat croup related coughs

What is laryngitis?

Laryngitis is the swelling of your voice box. It is often caused by an infection, mostly 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 simply means the swelling of the larynx. It generally results in a husky or hoarse voice that doesn’t last long.    

What is croup?

Croup is a condition in children that affects the trachea or wind pipe, the passage to their lungs or bronchi, and the larynx or voice box. 

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 this is very rare. Croup is mostly common in children between the ages of 6 months to 3 years. It will rarely occur in children who are 6 years and above. It is most common during late fall and all through the early winter. It slightly affects more boys as compared to girls. Treatment depends on whether it was caused by a virus or bacteria. 

How is croup diagnosed?

Croup is largely detected by physical exam. Your doctor will observe breathing patterns and a description of the symptoms or listening to the 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 it is not always that they will develop a much severe cough and stridor compared to children.

After some weeks, the person will not be considered contagious, even though the cough may still be present.

Spreading of croup

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: 

  • Fever
  • Hoarse voice
  • Breath shortness
  • Sore throat, discomfort when swallowing and inflamed neck glands
  • Stridor - a sound that has a high pitch and is evidenced when inhaling

Symptoms are more serious during the night. The baby will be awake, coughing and frightened.

Cause of croup in adults

Adult croup is a viral infection caused by a para influenza 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 that 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% in a household.

Some of the most profound symptoms of croup in adults include:

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

Later on, as the disease progresses, there is inflammation. Erythema and exudate are triggered due to the let-down 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 requiring 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 you have symptoms of croup, visit your doctor immediately.

Croup warning signs parents should look out for

Croup has been found to affect mostly young children. Major concerns arise if normal breathing is interrupted, because it can quickly develop into a life-threatening situation if ignored.

Constant monitoring should take place, and the doctor be 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 if there is uncontrolled drooling, problems when swallowing, blue discoloration of the skin most evident on the lips (cyanosis), sucking in of the chest and rapid breathing at 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 the cough, similar to that of the sound made by a barking seal.
  • Croup can be treated using moist and cool air, saltwater nose droplets, fluids, fever and pain prescription. 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 baby’s breathing.

Croup treatment

Take your baby to the hospital as soon as possible even if laryngitis has ever occurred before. The doctor can administer a dose of steroid to reduce the inflammation in the baby’s airways. If the right dose is given, the baby will be very safe.

The doctor will also give you some home treatment remedies to relieve the symptoms and help the baby feel comfortable. A doctor might tell you to:

  • Give the baby 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 low appetite.   
  • Give the infant ibuprofen or infant paracetamol (liquid) if the baby has a fever and is in agony. It will help the 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 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/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 steam the baby in a room that is well-closed but be very careful not to scald the baby.

Never give the baby decongestants as they do not treat croup related coughs.

Home remedies to alleviate croup symptoms

  1. Staying hydrated: Drinking plenty of fluid when ravaged with croup is essential. Water and breast milk work as the best hydrants for this condition for infants, but 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 which prevents dehydration and loosens mucus.
  2. Taking a hot steamy shower: Let hot water in the shower run whilst steam develops. Sit with the child for about 20 minutes while inhaling the steam to relieve the breathing pipe.
  3. Cool mist humidifier: If steam does not help, use a vaporizer in the 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.
  4. 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 air will relieve strenuous breathing.
  5. 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.
  6. Having some honey: Honey is a natural cough suppressant. It can be used to reduce coughing during sleep and also to induce sleep. Give a child one tea spoon to ease the cough, but do not give it to children below one year since there is a risk of poisoning caused by a toxin from anaerobic bacteria.
  7. Drinking 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.
  8. Ice pop: Children with a dry mouth and cough can be given popsicles since they soothe the sore throat as well as keep the mouth watery.
  9. 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 towards the tip and lift. Repeating the same process for 100-300 times may alleviate pain.
  10. Mustard: Make a paste with ¼ cup corn flour, one tea spoon 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 resulting from croup.
  11. 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.

Treat the fever

Don’t overdress the baby, avoid blankets and duvets. Applying a soft, wet towel on the forehead will help. Maintain appropriate room temperatures preferably not exceeding 66 to 68 degrees F.

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. It can worsen the situation. Visit a doctor if fever persists and if any other symptoms like vomiting, stomach pain or diarrhea occur.

Treatment of 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 include:

  • Getting enough rest: It is imperative to rest your vocal cords. For example, singers should limit their singing time to allow inflammation to heal. Also, 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, to allow healing.
  • Keeping hydrated: Drink enough fluids or keep your throat hydrated by sucking on lozenges. Your doctor can also advise you use humidifiers to keep your room moist to soothe your throat and ease congestion. Avoid caffeine and alcohol since they worsen the inflammation.
  • Taking medication: Your doctor will prescribe some antibiotics if bacteria is the cause of laryngitis. Viruses lead to 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 loose paralyzed vocal cords, it may be considered severe, and your doctor may recommend surgery. Removal of vocal polyps is common for outpatients.

People at high risk when infected with chronic laryngitis

  • Tobacco smokers and those repeatedly exposed to harmful fumes
  • Those infected with 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 conjunctiva of the nose or mouth and eyes. Para influenza viruses of type 1, 2, and 3 are notorious in causing croup epidemics yearly.

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 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, sub-mucosa and adventitia. The infiltrate contains erythrocytes and plasma cells.

The para influenza 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 pseudo-membranes may emanate, causing hazardous airway blockage. A deficiency of oxygen in blood may occur from 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 the viral disease; however, the reactions may be of allergic but not infectious origins.

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 an ambulance. 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 whistling-like sound
  • Can’t cry or talk 
  • Starts to become pale
  • Starts to drool excessively and swallowing gets difficult
  • Inhaling is increasing but breathing sound is fading
  • All of a sudden he/she seems sluggish or very sleepy
  • Looks like the neck and ribcage are drawing in

On arriving to the hospital, oxygen will be given to the baby to assist in breathing. Steroids can be can be administered orally or inhaled to minimize the inflammation in the airways.

The prevalence of croup

Worldwide, croup accounts for 15% of childhood acute stridor emergencies. It occurs mostly 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 with rare occurrences afterwards. The male to female ratio is an estimated 1.4:1.

Croup is more common in late autumn and early winter than any other time. 5% of children will be re-infected 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 go 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 then subdue 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, it may not be hazardous and will require a course of antibiotic treatment depending on the severity. If dangerous symptoms develop, it is vital to seek medical treatment immediately.

Croup prognosis and outlook

The prognosis is excellent with an almost assured total recovery. Since it is rarely severe, many casualties can be handled in outpatient. During the 1990s, annual hospitalizations averaged 41,000 but currently the number is much 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%.

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 hyper-responsiveness and sensitivity to skin testing.

Other factors that aid development of asthma is recurrent croup, family asthma history, and exposure to smoke.

Is croup preventable?

Currently, there isn’t any 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 extended considerably.

Frequently washing hands and avoiding contact with infected people will help prevent against croup.

What happens if croup goes untreated?

It is rare for croup to develop into severe conditions which require hospitalization or steroid medication.

Croup can be handled at home by ensuring there is a steady flow of cool and moist fresh air.

When to seek medical help

Acute laryngitis cases are manageable using simple self-care guidelines, like resting the voice and taking lots of fluid. When babies use their voice strenuously it will cause more damage to the vocal cords.     

Make a doctor’s appointment if the symptoms last for more than 2 weeks.

It is advisable to see a doctor if your baby is:

  • Having a hard time breathing
  • Coughing up blood
  • Experiencing a fever that is not going away
  • Experiencing more pain
  • Having a rough time swallowing

Visit a doctor immediately if the child:

  • Makes noise when inhaling, producing high-pitched inhaling sounds
  • Drools more than normal
  • Has a problem while swallowing
  • Is struggling to breathe 
  • Has a high fever exceeding 103 F 

The above signs and symptoms might point to croup infection, swelling of the larynx and air passage beneath it. Croup can easily be treated from home, but serious symptoms need medical attention. The above symptoms can also be associated with epiglottis, whereby the tissue acting like a lid that covers the wind pipe becomes swollen. This condition is usually life-threatening both in children and adults.  

Preparing for your appointment

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

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, medications and vaccinations, or if there is any noticeable pattern of coughing that has developed.

Tips to help you maintain the health of your vocal cords

If you want to keep your voice box and vocal cords healthy make sure they are always moist and keep away from irritants. Here are some various ways of avoiding irritants.

  • Stop smoking or stay away from people that smoke
  • Reduce alcohol and caffeine consumption
  • Always wash your hands to avoid getting colds or upper respiratory infections
  • Keep away from toxic chemicals at the workplace whenever possible
  • Use a pillow to raise the head while sleeping to protect one's larynx against acid reflux from the stomach when asleep
  • Avoid shouting and singing for long durations

In addition, refrain from clearing the throat as it increases mucus production and causes irritation.