- Herpes simplex virus (HSV) laryngitis manifests differently in adult vs pediatric patients because of differences in laryngeal anatomy, according to this systematic review.
- Although rare, HSV laryngitis is associated with multiweek hospital stays, possible tracheostomy, and other significant outcomes.
Why this matters
- HSV laryngitis is in the differential for patients presenting with stridor, dyspnea, and dysphonia unresponsive to first-line empiric antibiotics, steroids.
- Absence of ulcerations does not rule out HSV laryngitis.
- 31 articles included, with 17 children (average age, 11 months) and 19 adults (average age, 52 years).
- Pediatric presentation: stridor (94%; P<.001 vs adults>shortness of breath (76%), fever (50%), and cough (50%).
- Adult presentation: dysphonia (58%), dysphagia (53%), shortness of breath (45%), and stridor (30%).
- Adults had more dysphagia (P=.03) and dysphonia (P<.01 than did children.>
- HSV lesions on laryngoscopy:
- Children: true vocal cords (50%), epiglottis (44%), arytenoids (29%).
- Adults: true vocal cords (74%).
- Children: endotracheal intubation (50%), tracheotomy (6%), no airway support (47%).
- Adults: tracheotomy (37%, P=.05 vs pediatrics), no airway support (58%).
- Mean length of hospital stay: 21 days for children vs 16 for adults.
- Medical management (intravenous acyclovir, antibiotics, oral acyclovir/valacyclovir) varied.
- Systematic review.
- Funding: None disclosed.
- Selection bias.
- Limited data.