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Introduction: Authors present four cases of acute suppurative thyroiditis treated in our department. Initial symptoms are similar to acute pharyngitis or laryngitis but could end in fulminant course that could be life threatening., Material and Methods: We present etiology, clinical symptoms and accessory exams as well as new treatment methods., Results: All four patients were cured. In one case pharmacological treatment was sufficient. In second case the patient needed intubation due to stridor. In third one after pharmacological treatment we performed partial thyroidectomy. In last case patient with thyroid abscess needed urgent thyroidectomy due to retropharyngeal and mediastinal multiple abscesses., Conclusions: Acute suppurative thyroiditis needs hospitalisation. Some patients needed surgical intervention due to life threatening course.

Subglottic laryngitis is one of the acute children's diseases, directly caused by a violently growing edema of the subglottic area. Its symptoms generally appear very suddenly, when children seem to be in perfect health, at night, several hours after falling asleep. Their symptoms included barking cough, clear voice, stridor, inspiratory dyspnoea with participation of auxiliary respiratory muscles, excitation and anxiety of a child, changes in skin coloration. The movement of the wings of the nostrils is intensified. In especially severe cases, agitation, cyanosis, pallor of skin, obnubilation, apnea, loss of consciousness and circulatory failure may also occur. Subglottic laryngitis is a disease, which can threaten the life of a small child. The aim of this study was to observe efficacy of the treatment of the subglottic laryngitis with glucocorticoids, especially budesonide in nebulization. The research covered 169 children: 58 girls (34.31%) and 111 boys (65.69%) aged 9. months do 5. years (mean 3 years 6 months) hospitalized in the Children's Hospital in Warsaw with the following symptoms: dry barking cough, stridor, inspiratory dyspnoea with the participation of auxiliary respiratory muscles, agitation and change of colour of skin. The examination of each patient included subjective, objective (pediatric and laryngological). Disease severity was assessed by a clinical croup score based on stridor, cough retractions, dyspnoea and cyanosis and the overall clinical assessment was scored on a visual scale. The results indicate that nebulised budesonide can be used as a safe and effective alternative treatment in children with moderate to severe subglottic laryngitis.

Unlabelled: Croup syndrome is an urgent and frequent reason for hospitalization of children., Material and Methods: 632 children with croup syndrome (422 boys and 210 girls aged 2 months-17 years) admitted to 15 pediatric departments in Lower Silesia were prospectively observed for 12 months (from April 2001 to March 2002). We conducted prospective survey of clinical and laboratory data from all study centers., Results: Following diagnoses were accepted as the croup syndrome: subglottic laryngitis in 482 patients (75.4%), laryngotracheobronchitis in 75 (11.8%), laryngitis in 50 (7.8%) and epiglottitis in 20 children (3%). The most severe course was observed in children with epiglottitis. Four of them required airway intervention and had endotracheal intubation. H. influenzae b was cultured from blood of one patient. The most cases of epiglottitis occurred in the 3rd year of life (45%)., Conclusions: 1. The most common reason of croup was subglottic laryngitis. 2. Epiglottitis was rare with serious course of disease; frequency was comparable with the frequency seen in European countries before the implementation of Hib vaccine. The routine use of Hib vaccine in Poland may prevent from children life threatening epiglottis cases.

A case of severe laryngeal diphtheria in a young woman was presented. Initially, the presence of a foreign body in the larynx of this patient was suspected. The differential diagnosis of a foreign body should include diphtheric laryngitis as this may cause obstruction of the respiratory tract. This can lead to severe complications.

A case of 56 year old woman, diabetic (non-diagnosed before), suffering from diffuse phlegmon of the neck and acute submucosal laryngitis as a peritonsillar abscess complication is presented. Tracheotomy, abscess tonsillectomy with evacuation of peritonsillar abscess and extensive skin incisions of the neck with separation of tissue layers followed by drainage were performed at the beginning of hospitalization. This was regarded as responsible for stopping the violent development of the disease and saving the life of patient. Pathological bacteria were Streptococci (anaerobic and aerobic). Apart from the application of antibiotics (piperacyl, amikin, metronidazole) the patient was treated by hyperbaric oxygen (pressure 2,5 ata, one hour per day, on 6-9 day of treatment). Furthermore she was treated with oxygen applied through the tracheotomy tube during 5 days. In the authors' opinion the early performance of surgical procedure is necessary in the phlegmon of the neck as in the presented case. It is to be remembered, that these patients may suffer from other diseases like diabetes, non-diagnosed earlier. It has been noticed that significant improvement may be obtained by using the hyperbaric oxygen in the treatment of such cases.