Les Dyspnées Laryngotrachéales de l’Enfant au CHU de Brazzaville : Aspects Épidémiologiques, Diagnostiques et Thérapeutiques

RESUME Introduction. La dyspnee laryngee est une bradypnee inspiratoire pouvant s’accompagner de tirage et cornage. La gene expiratoire y est associee en cas de participation tracheale. L’objectif de cette etude etait de decrire les aspects epidemiologiques, diagnostiques et therapeutiques des dyspnees laryngotracheales de l’enfant au CHU de Brazzaville et d’identifier les etiologies en cause. Materiels et methodes. Il s’agit d’une etude observationnelle, retrospective, descriptive et transversale menee dans le service d’orl et de pediatrie du chu de Brazzaville de janvier 1996 a decembre 2006 soit 20 ans. Tous les patients de moins de 17 ans recus pendant la periode d’etude, et qui presentaient une dyspnee laryngotracheale, pour lequel le bilan etiologique avait ete effectue, ont ete inclus dans cette etude. Resultats. La frequence hospitaliere a ete estimee a 0,57%. L’âge moyen etait de 6,83 ans avec des extremes de 1a 14 ans. Le sexe feminin representait 59% (n=50) contre 41%(n=35) de sexe masculin. Les patients provenaient des services d’ORL dans 60% des cas (n=51), des services de pediatrie dans 35% des cas (n=30) et de la reanimation dans 5% des cas (n=4). La dyspnee laryngee isolee a ete retrouvee chez 76% des patients(n=65) et les etiologies en cause etaient dominees par les laryngites dans 32% des cas(n=27), les corps etrangers laryngotracheaux dans 26% (n=22), la papillomatose laryngee dans 18% des cas (n=21) et les angiomes sous glottiques dans 2% (n=2).le traitement medical comportant l’antibiocorticotherapie a ete effectue dans 24% des cas(n=30). La tracheotomie et l’endoscopie y etaient associees dans 8% des cas (n=7). L’evolution etait favorable chez 97,64% des patients (n=83). Conclusion. La dyspnee laryngotracheale est une urgence medicochirurgicale qui peut engager le pronostic vital. Le traitement etiologique est specifique a chaque pathologie et le resultat est fonction de l’etiologie. ABSTRACT Introduction. Laryngeal dyspnea is an inspiratory bradypnea that can be accompanied by pulling and whirling. Expiratory dyspnea is associated with tracheal involvement. The aim of this study was to describe the epidemiological, diagnostic and therapeutic aspects of laryngotracheeal dyspnea in children in Brazzaville and to identify the etiologies involved. Materials and methods. This was an observational, retrospective, descriptive and cross-sectional study conducted in the ENT and Pediatric Department of the Teaching Hospital of Brazzaville, from January 1996 to December 2006(20 years). All patients less than 17 years of age received during the study period who had laryngotracheal dyspnea for which the etiological assessment was performed were included in this study. Results. The hospital frequency was estimated at 0.57%. The average age was 6.83 years with extremes of 1 to 14 years. Females accounted for 59% (n = 50) versus 41% (n = 35) of males. Patients were provided by ENT services in 60% of cases (n = 51), pediatric services in 35% of cases (n = 30) and resuscitation in 5% of patients. (n = 4). Isolated laryngeal dyspnea was found in 76% of patients (n = 65) and the etiologies were dominated by laryngitis in 32% of cases (n = 27), laryngotracheal foreign bodies in 26% (n = 22), laryngeal papillomatosis in 18% of cases (n=21) and subglottic angiomas in 2% (n=2). Medical treatment with antibiocorticotherapy was performed in 24% of cases (n = 30). Tracheotomy and endoscopy were associated in 8% of cases (n = 7). Clinical course was favorable in 97.64% of patients (n = 83). Conclusion. Laryngotracheal dyspnea is a medical and surgical emergency that can be life threatening. The etiological treatment is specific to each pathology and the result depends on the etiology.