Tracheitis differential diagnosis: Difference between revisions
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[[ear pain]], [[difficulty breathing]], [[headache]], [[dizziness]]. | [[ear pain]], [[difficulty breathing]], [[headache]], [[dizziness]]. | ||
| rowspan="4" |[[Sore throat]], pain on swallowing, [[fever]], [[headache]], [[cough]] | | rowspan="4" |[[Sore throat]], pain on swallowing, [[fever]], [[headache]], [[cough]] | ||
| rowspan="4" |[[Neck pain]], [[stiff neck]], [[torticollis]] | | rowspan="4" | | ||
* [[Neck pain]], s[[stiff neck|tiff neck]], [[torticollis]] | |||
[[fever]], [[malaise]], [[stridor]], and barking [[cough]] | [[fever]], [[malaise]], [[stridor]], and barking [[cough]] | ||
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|Signs of respiratory distress, intermittent [[wheezing]]. Inspiratory [[stridor]]. <ref name="pmid26132943" /> | |Signs of respiratory distress, intermittent [[wheezing]]. Inspiratory [[stridor]]. <ref name="pmid26132943" /> | ||
|- | |- | ||
|Age | |Age | ||
| colspan="2" |Mainly 6 months and 3 years old | | colspan="2" |Mainly 6 months and 3 years old | ||
rarely, adolescents and adults<ref name="pmid8769531">{{cite journal| author=Tong MC, Chu MC, Leighton SE, van Hasselt CA| title=Adult croup. | journal=Chest | year= 1996 | volume= 109 | issue= 6 | pages= 1659-62 | pmid=8769531 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8769531 }}</ref> | rarely, adolescents and adults<ref name="pmid8769531">{{cite journal| author=Tong MC, Chu MC, Leighton SE, van Hasselt CA| title=Adult croup. | journal=Chest | year= 1996 | volume= 109 | issue= 6 | pages= 1659-62 | pmid=8769531 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8769531 }}</ref> | ||
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between the ages of 5 to 24 years.<ref>{{cite book | last = Bennett | first = John | title = Mandell, Douglas, and Bennett's principles and practice of infectious diseases | publisher = Elsevier/Saunders | location = Philadelphia, PA | year = 2015 | isbn = 978-1455748013 }}</ref> | between the ages of 5 to 24 years.<ref>{{cite book | last = Bennett | first = John | title = Mandell, Douglas, and Bennett's principles and practice of infectious diseases | publisher = Elsevier/Saunders | location = Philadelphia, PA | year = 2015 | isbn = 978-1455748013 }}</ref> | ||
|Mostly | | | ||
| | * Mostly the first six years of life | ||
| | |||
between 5 and 15 years old | * Children between 5 and 15 years old<ref name="Oroface">{{cite book |last1=Sharav |first1=Yair |last2=Benoliel |first2=Rafael |date=2008 |title=Orofacial Pain and Headache |url= |location= |publisher=Elsevier |page= |isbn=0723434123}}</ref> | ||
|Mostly between 2-4 years, but can occur in other age groups.<ref name="pmid12777558">{{cite journal| author=Craig FW, Schunk JE| title=Retropharyngeal abscess in children: clinical presentation, utility of imaging, and current management. | journal=Pediatrics | year= 2003 | volume= 111 | issue= 6 Pt 1 | pages= 1394-8 | pmid=12777558 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12777558 }}</ref><ref name="pmid1876473">{{cite journal| author=Coulthard M, Isaacs D| title=Neonatal retropharyngeal abscess. | journal=Pediatr Infect Dis J | year= 1991 | volume= 10 | issue= 7 | pages= 547-9 | pmid=1876473 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1876473 }}</ref> | |Mostly between 2-4 years, but can occur in other age groups.<ref name="pmid12777558">{{cite journal| author=Craig FW, Schunk JE| title=Retropharyngeal abscess in children: clinical presentation, utility of imaging, and current management. | journal=Pediatrics | year= 2003 | volume= 111 | issue= 6 Pt 1 | pages= 1394-8 | pmid=12777558 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12777558 }}</ref><ref name="pmid1876473">{{cite journal| author=Coulthard M, Isaacs D| title=Neonatal retropharyngeal abscess. | journal=Pediatr Infect Dis J | year= 1991 | volume= 10 | issue= 7 | pages= 547-9 | pmid=1876473 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1876473 }}</ref> | ||
|May be congenital congenital or acquired. Mean age in acquired is 54.1 years<ref name="pmid28007041">{{cite journal| author=Nicolli EA, Carey RM, Farquhar D, Haft S, Alfonso KP, Mirza N| title=Risk factors for adult acquired subglottic stenosis. | journal=J Laryngol Otol | year= 2017 | volume= 131 | issue= 3 | pages= 264-267 | pmid=28007041 | doi=10.1017/S0022215116009798 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28007041 }}</ref> | |May be congenital congenital or acquired. Mean age in acquired is 54.1 years<ref name="pmid28007041">{{cite journal| author=Nicolli EA, Carey RM, Farquhar D, Haft S, Alfonso KP, Mirza N| title=Risk factors for adult acquired subglottic stenosis. | journal=J Laryngol Otol | year= 2017 | volume= 131 | issue= 3 | pages= 264-267 | pmid=28007041 | doi=10.1017/S0022215116009798 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28007041 }}</ref> | ||
|- | |- | ||
|Imaging finding | |Imaging finding | ||
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|Lateral neck xray shows intraluminal membranes and tracheal wall irregularity. | |Lateral neck xray shows intraluminal membranes and tracheal wall irregularity. | ||
|Intraoral or transcutaneous USG may show an abscess making CT scan unnecessary.<ref name="pmid26527518">{{cite journal| author=Kawabata M, Umakoshi M, Makise T, Miyashita K, Harada M, Nagano H et al.| title=Clinical classification of peritonsillar abscess based on CT and indications for immediate abscess tonsillectomy. | journal=Auris Nasus Larynx | year= 2016 | volume= 43 | issue= 2 | pages= 182-6 | pmid=26527518 | doi=10.1016/j.anl.2015.09.014 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26527518 }} </ref><ref name="pmid25946659">{{cite journal| author=Nogan S, Jandali D, Cipolla M, DeSilva B| title=The use of ultrasound imaging in evaluation of peritonsillar infections. | journal=Laryngoscope | year= 2015 | volume= 125 | issue= 11 | pages= 2604-7 | pmid=25946659 | doi=10.1002/lary.25313 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25946659 }} </ref><ref name="pmid25945805">{{cite journal| author=Fordham MT, Rock AN, Bandarkar A, Preciado D, Levy M, Cohen J et al.| title=Transcervical ultrasonography in the diagnosis of pediatric peritonsillar abscess. | journal=Laryngoscope | year= 2015 | volume= 125 | issue= 12 | pages= 2799-804 | pmid=25945805 | doi=10.1002/lary.25354 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25945805 }} </ref> | |Intraoral or transcutaneous USG may show an abscess making CT scan unnecessary.<ref name="pmid26527518">{{cite journal| author=Kawabata M, Umakoshi M, Makise T, Miyashita K, Harada M, Nagano H et al.| title=Clinical classification of peritonsillar abscess based on CT and indications for immediate abscess tonsillectomy. | journal=Auris Nasus Larynx | year= 2016 | volume= 43 | issue= 2 | pages= 182-6 | pmid=26527518 | doi=10.1016/j.anl.2015.09.014 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26527518 }} </ref><ref name="pmid25946659">{{cite journal| author=Nogan S, Jandali D, Cipolla M, DeSilva B| title=The use of ultrasound imaging in evaluation of peritonsillar infections. | journal=Laryngoscope | year= 2015 | volume= 125 | issue= 11 | pages= 2604-7 | pmid=25946659 | doi=10.1002/lary.25313 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25946659 }} </ref><ref name="pmid25945805">{{cite journal| author=Fordham MT, Rock AN, Bandarkar A, Preciado D, Levy M, Cohen J et al.| title=Transcervical ultrasonography in the diagnosis of pediatric peritonsillar abscess. | journal=Laryngoscope | year= 2015 | volume= 125 | issue= 12 | pages= 2799-804 | pmid=25945805 | doi=10.1002/lary.25354 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25945805 }} </ref> | ||
| | |'''CT scan:''' | ||
* a mass impinging on the posterior pharyngeal wall with rim enhancement is seen<ref name="pmid15667676">{{cite journal| author=Philpott CM, Selvadurai D, Banerjee AR| title=Paediatric retropharyngeal abscess. | journal=J Laryngol Otol | year= 2004 | volume= 118 | issue= 12 | pages= 919-26 | pmid=15667676 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15667676 }}</ref><ref name="pmid12761699">{{cite journal| author=Vural C, Gungor A, Comerci S| title=Accuracy of computerized tomography in deep neck infections in the pediatric population. | journal=Am J Otolaryngol | year= 2003 | volume= 24 | issue= 3 | pages= 143-8 | pmid=12761699 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12761699 }}</ref> | |||
|Bronchoscopy reveals subglottic stenosis. Computed tomography may reveal a concentric stenotic tracheal segment.<ref name="pmid261329432">{{cite journal| author=Nussbaumer-Ochsner Y, Thurnheer R| title=IMAGES IN CLINICAL MEDICINE. Subglottic Stenosis. | journal=N Engl J Med | year= 2015 | volume= 373 | issue= 1 | pages= 73 | pmid=26132943 | doi=10.1056/NEJMicm1404785 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26132943 }}</ref> | |Bronchoscopy reveals subglottic stenosis. Computed tomography may reveal a concentric stenotic tracheal segment.<ref name="pmid261329432">{{cite journal| author=Nussbaumer-Ochsner Y, Thurnheer R| title=IMAGES IN CLINICAL MEDICINE. Subglottic Stenosis. | journal=N Engl J Med | year= 2015 | volume= 373 | issue= 1 | pages= 73 | pmid=26132943 | doi=10.1056/NEJMicm1404785 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26132943 }}</ref> | ||
|- | |- |
Revision as of 13:50, 1 June 2020
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Prince Tano Djan, BSc, MBChB [2]
Overview
Differentiating tracheitis from other diseases
Bacteria tracheitis must be differentiated from other causes of throat pain as shown below:
Variable | Croup | Epiglottitis | Pharyngitis | Bacterial tracheitis | Tonsilitis | Retropharyngeal abscess | Subglottic stenosis | |
---|---|---|---|---|---|---|---|---|
Presentation | Cough | ✔ | — | Sore throat, pain on swallowing, fever, headache, abdominal pain, nausea and vomiting | Barking cough, stridor, | Sore throat, pain on swallowing, fever, headache, cough | Depends on severity. May have respiratory distress at birth, exercise-induced dyspnea, intermittent wheezing. Inspiratory stridor. [1] | |
Stridor | ✔ | ✔ | ||||||
Drooling | — | ✔ | ||||||
Others are Hoarseness, Difficulty breathing, symptoms of the common cold, Runny nose, Fever | Other symptoms include difficulty breathing, fever, chills, difficulty swallowing, hoarseness of voice | |||||||
Causes | Parainfluenza virus | H. influenza type b, beta-hemolytic streptococci, Staphylococcus aureus, fungi and viruses. | Group A beta-hemolytic streptococcus. | Staphylococcus aureus | Most common cause is viral including adenovirus, rhinovirus, influenza, coronavirus, and respiratory syncytial virus. Second most common causes are bacterial; Group A streptococcal bacteria,[2] | Polymicrobial infection. Mostly; Streptococcus pyogenes, Staphylococcus aureus and respiratory anaerobes (example; Fusobacteria, Prevotella, and Veillonella species)[3][4][5][6][7][8] | Congenital, trauma | |
Physical exams findings | Suprasternal and intercostal indrawing,[9] Inspiratory stridor[10], expiratory wheezing,[10] Sternal wall retractions[11] | Cyanosis, Cervical lymphadenopathy, Inflammed epiglottis | Inflammed pharynx with or without exudate | Subglottic narrowing with purulent secretions in the trachea[12][13] | Fever, especially 100°F or higher.[14][15]Erythema, edema and Exudate of the tonsils.[16] cervical lymphadenopathy, Dysphonia.[17] | Child may be unable to open the mouth widely. May have enlarged
cervical lymph nodes and neck mass. |
Signs of respiratory distress, intermittent wheezing. Inspiratory stridor. [1] | |
Age | Mainly 6 months and 3 years old
rarely, adolescents and adults[18] |
Used to be mostly found in
pediatric age group between 3 to 5 years, however, recent trend favors adults as most commonly affected individuals[19] with a mean age of 44.94 years. |
Mostly in children and young adults,
with 50% of cases identified between the ages of 5 to 24 years.[20] |
|
|
Mostly between 2-4 years, but can occur in other age groups.[22][23] | May be congenital congenital or acquired. Mean age in acquired is 54.1 years[24] | |
Imaging finding | Steeple sign on neck X-ray | Thumbprint sign on neck x-ray | — | Lateral neck xray shows intraluminal membranes and tracheal wall irregularity. | Intraoral or transcutaneous USG may show an abscess making CT scan unnecessary.[25][26][27] | CT scan: | Bronchoscopy reveals subglottic stenosis. Computed tomography may reveal a concentric stenotic tracheal segment.[30] | |
Treatment | Dexamethasone and nebulised epinephrine | Airway maintenance, parenteral Cefotaxime or Ceftriaxone in combination with Vancomycin. Adjuvant therapy includes corticosteroids and racemic Epinephrine.[31][32] | Antimicrobial therapy mainly penicillin-based and analgesics. | Airway maintenance and antibiotics | Antimicrobial therapy mainly penicillin-based and analgesics with tonsilectomy in selected cases. | Immediate surgical drainage and antimicrobial therapy. emperic therapy involves; ampicillin-sulbactam or clindamycin. | Endoscopic balloon dilation for patients with low-grade subglottic stenosis,[33] glucocorticoid injections, and resection.[34] |
References
- ↑ 1.0 1.1 Nussbaumer-Ochsner Y, Thurnheer R (2015). "IMAGES IN CLINICAL MEDICINE. Subglottic Stenosis". N Engl J Med. 373 (1): 73. doi:10.1056/NEJMicm1404785. PMID 26132943.
- ↑ Putto A (1987). "Febrile exudative tonsillitis: viral or streptococcal?". Pediatrics. 80 (1): 6–12. PMID 3601520.
- ↑ Cheng J, Elden L (2013). "Children with deep space neck infections: our experience with 178 children". Otolaryngol Head Neck Surg. 148 (6): 1037–42. doi:10.1177/0194599813482292. PMID 23520072.
- ↑ Abdel-Haq N, Quezada M, Asmar BI (2012). "Retropharyngeal abscess in children: the rising incidence of methicillin-resistant Staphylococcus aureus". Pediatr Infect Dis J. 31 (7): 696–9. doi:10.1097/INF.0b013e318256fff0. PMID 22481424.
- ↑ Inman JC, Rowe M, Ghostine M, Fleck T (2008). "Pediatric neck abscesses: changing organisms and empiric therapies". Laryngoscope. 118 (12): 2111–4. doi:10.1097/MLG.0b013e318182a4fb. PMID 18948832.
- ↑ Brook I (2004). "Microbiology and management of peritonsillar, retropharyngeal, and parapharyngeal abscesses". J Oral Maxillofac Surg. 62 (12): 1545–50. PMID 15573356.
- ↑ Wright CT, Stocks RM, Armstrong DL, Arnold SR, Gould HJ (2008). "Pediatric mediastinitis as a complication of methicillin-resistant Staphylococcus aureus retropharyngeal abscess". Arch Otolaryngol Head Neck Surg. 134 (4): 408–13. doi:10.1001/archotol.134.4.408. PMID 18427007.
- ↑ Asmar BI (1990). "Bacteriology of retropharyngeal abscess in children". Pediatr Infect Dis J. 9 (8): 595–7. PMID 2235179.
- ↑ Johnson D (2009). "Croup". BMJ Clin Evid. 2009. PMC 2907784. PMID 19445760.
- ↑ 10.0 10.1 Cherry, James D. (2008). "Croup". New England Journal of Medicine. 358 (4): 384–391. doi:10.1056/NEJMcp072022. ISSN 0028-4793.
- ↑ Johnson D (2009). "Croup". BMJ Clin Evid. 2009. PMC 2907784. PMID 19445760.
- ↑ Liston SL, Gehrz RC, Siegel LG, Tilelli J (1983). "Bacterial tracheitis". Am J Dis Child. 137 (8): 764–7. PMID 6869336.
- ↑ Liston SL, Gehrz RC, Jarvis CW (1981). "Bacterial tracheitis". Arch Otolaryngol. 107 (9): 561–4. PMID 7271556.
- ↑ Tonsillitis. Medline Plus. https://www.nlm.nih.gov/medlineplus/ency/article/001043.htm. Accessed May 2nd, 2016.
- ↑ "Tonsillitis - NHS Choices".
- ↑ Stelter K (2014). "Tonsillitis and sore throat in children". GMS Curr Top Otorhinolaryngol Head Neck Surg. 13: Doc07. doi:10.3205/cto000110. PMC 4273168. PMID 25587367.
- ↑ "Tonsillitis - Symptoms - NHS Choices".
- ↑ Tong MC, Chu MC, Leighton SE, van Hasselt CA (1996). "Adult croup". Chest. 109 (6): 1659–62. PMID 8769531.
- ↑ Lichtor JL, Roche Rodriguez M, Aaronson NL, Spock T, Goodman TR, Baum ED (2016). "Epiglottitis: It Hasn't Gone Away". Anesthesiology. 124 (6): 1404–7. doi:10.1097/ALN.0000000000001125. PMID 27031010.
- ↑ Bennett, John (2015). Mandell, Douglas, and Bennett's principles and practice of infectious diseases. Philadelphia, PA: Elsevier/Saunders. ISBN 978-1455748013.
- ↑ Sharav, Yair; Benoliel, Rafael (2008). Orofacial Pain and Headache. Elsevier. ISBN 0723434123.
- ↑ Craig FW, Schunk JE (2003). "Retropharyngeal abscess in children: clinical presentation, utility of imaging, and current management". Pediatrics. 111 (6 Pt 1): 1394–8. PMID 12777558.
- ↑ Coulthard M, Isaacs D (1991). "Neonatal retropharyngeal abscess". Pediatr Infect Dis J. 10 (7): 547–9. PMID 1876473.
- ↑ Nicolli EA, Carey RM, Farquhar D, Haft S, Alfonso KP, Mirza N (2017). "Risk factors for adult acquired subglottic stenosis". J Laryngol Otol. 131 (3): 264–267. doi:10.1017/S0022215116009798. PMID 28007041.
- ↑ Kawabata M, Umakoshi M, Makise T, Miyashita K, Harada M, Nagano H; et al. (2016). "Clinical classification of peritonsillar abscess based on CT and indications for immediate abscess tonsillectomy". Auris Nasus Larynx. 43 (2): 182–6. doi:10.1016/j.anl.2015.09.014. PMID 26527518.
- ↑ Nogan S, Jandali D, Cipolla M, DeSilva B (2015). "The use of ultrasound imaging in evaluation of peritonsillar infections". Laryngoscope. 125 (11): 2604–7. doi:10.1002/lary.25313. PMID 25946659.
- ↑ Fordham MT, Rock AN, Bandarkar A, Preciado D, Levy M, Cohen J; et al. (2015). "Transcervical ultrasonography in the diagnosis of pediatric peritonsillar abscess". Laryngoscope. 125 (12): 2799–804. doi:10.1002/lary.25354. PMID 25945805.
- ↑ Philpott CM, Selvadurai D, Banerjee AR (2004). "Paediatric retropharyngeal abscess". J Laryngol Otol. 118 (12): 919–26. PMID 15667676.
- ↑ Vural C, Gungor A, Comerci S (2003). "Accuracy of computerized tomography in deep neck infections in the pediatric population". Am J Otolaryngol. 24 (3): 143–8. PMID 12761699.
- ↑ Nussbaumer-Ochsner Y, Thurnheer R (2015). "IMAGES IN CLINICAL MEDICINE. Subglottic Stenosis". N Engl J Med. 373 (1): 73. doi:10.1056/NEJMicm1404785. PMID 26132943.
- ↑ Nickas BJ (2005). "A 60-year-old man with stridor, drooling, and "tripoding" following a nasal polypectomy". J Emerg Nurs. 31 (3): 234–5, quiz 321. doi:10.1016/j.jen.2004.10.015. PMID 15983574.
- ↑ Wick F, Ballmer PE, Haller A (2002). "Acute epiglottis in adults". Swiss Med Wkly. 132 (37–38): 541–7. PMID 12557859.
- ↑ Cui PC, Luo JS, Zhao DQ, Guo ZH, Ma RN (2016). "[Management of subglottic stenosis in children with endoscopic balloon dilation]". Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 51 (4): 286–8. doi:10.3760/cma.j.issn.1673-0860.2016.04.009. PMID 27095722.
- ↑ Nussbaumer-Ochsner Y, Thurnheer R (2015). "IMAGES IN CLINICAL MEDICINE. Subglottic Stenosis". N Engl J Med. 373 (1): 73. doi:10.1056/NEJMicm1404785. PMID 26132943.