Herpes simplex laryngitis: laryngeal anatomy drives different presentations in children vs adults

  • Bachrach K & al.
  • Int J Pediatr Otorhinolaryngol
  • 24 Dec 2020

  • curated by Liz Scherer
  • Clinical Essentials
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Takeaway

  • 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.

Key results

  • 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%).
  • Management: 
    • 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.

Study design

  • Systematic review.
  • Funding: None disclosed.

Limitations

  • Selection bias.
  • Limited data.