Date: Fri 17-Oct-1997

Publication: Hea

Author: JUDYC

Quick Words:

pediatrician-throat-polio

Full Text:

PEDIATRICIAN'S JOURNAL for 10/17/97 HEALTH MONITOR

By Jeff Ceronsky, MD

My five-year-old has a wicked sore throat, a cough, and a fever, and he's lost

his voice. I took him to his pediatrician, but she didn't even do a throat

culture and didn't start antibiotics. Is this right?

Your child has all the classic symptoms of laryngitis. Literally, laryngitis

means inflammation of the voicebox, but the term is used primarily for an

infection of the area around the voicebox. This infection, in healthy children

without any immunodeficiencies (problems with their immune system), is always

caused by a virus. The most common virus that can cause this infection is one

called parainfluenza virus.

The key word here is virus. Antibiotics play no part in the treatment of

viruses, and therefore are not used to treat laryngitis.

The first thing a doctor should look at is the throat. Is it red? Doing a

throat culture in a child is predicated on the possibility of strep throat

(There is no other bacteria or virus worth culturing for in your standard sore

throat). Laryngitis is a viral illness, and it affects the airway much farther

down than the throat. For laryngitis symptoms, with no visible redness in the

throat, a throat culture or strep screen is not indicated. Ten to 20 percent

of normal-looking throats will culture positive for strep. If you culture a

throat that is not red (as in this case), and come back with a culture that is

positive for strep, it simply means that you've identified one of these

carriers. The carrier state need not be treated, and treatment with

unnecessary antibiotics causes bacteria to become more and more resistant to

the antibiotics we can use.

Treatment of laryngitis is geared to make the symptoms less bothersome to the

child. Acetaminophen (Tylenol) is appropriate for fever or sore throat. Cough

medicines offer a small amount of relief. However, the most effective

treatment is humidity. This humidity can be provided by a humidifier or a

vaporizer running on plain water. The humidity helps soothe the voicebox,

decreasing irritation and inflammation. The illness will, however, have to

"run its course, " which usually takes about a week.

Reasons to see a physician include a red-looking throat, drooling, difficulty

breathing, fever over 104§F, or any unusual symptom not mentioned above.

My doctor recommended going to the polio shot rather than the polio vaccine

given by mouth. Which is better?

Both the oral (Sabin) and the injectable (Salk) polio vaccines are very

effective, although some may argue that the live vaccine contained in the oral

polio vaccine may provide better community coverage as one child can catch the

virus that's in the vaccine from another child.

The reason that many doctors are now offering the injectable vaccine stems

from concern for the two to ten cases per year of polio caused by the oral

vaccine. However, when put in perspective of the millions of doses of vaccine

given every year, this number is quite small. And we do not have enough

experience with the injectable vaccine to rule out a comparable complication.

The bottom line is that either vaccine is extremely safe, valuable, and

effective in helping to eradicate polio in the near future.