Diagnosis.—In reading the above description of the phenomena attend ing upon suppuration about the larynx the resemblance of the disease, in its course and symptoms, to retro-pharyngeal abscess cannot fail to be re marked. We find in each instance difficulty of swallowing, paroxysmal dyspncea and stridulous breathing, and a marked increase in the child's distress when he lies down. In either case, too, the trachea may be pushed out of place and may be more prominent than natural. The chief distin guishing mark is the presence of a tumour in the fauces if the abscess is situated behind the pharynx ; while if the suppuration occurs around the larynx the fauces are natural.
The distinction between such a condition and membranous croup is described elsewhere (see page 594). It may, however, be here noticed that in children who are old enough to sit upright, orthopncea is a very charac teristic symptom of interference with the passage of air through the larynx. and trachea from outside pressure. In membranous croup no such symptom is noticed, for in that disease there is no aggravation of the dyspncea when the child is recumbent. On the contrary, he often breathes more easily in that position. Again, the progression of the symptoms is more gradual in the case of abscess. The stertor comes on more slowly and increases in intensity as the sac increases in size.
Prognosis.—The prospect of recovery depends upon the general health of the child, and upon the appearance of local swelling or fluctuation at some point in the front of the neck. If the abscess can be detected and its contents evacuated, recovery may take place ; but if the child be a feeble cachectic subject, especially if he be much exhausted by sleeplessness and want of food, the operation may come too late to save life. In this disease
the prognosis is distinctly less favourable than it is in retropharyngeal abscess., Treatrnent.—If the presence of an abscess about the larynx be suspected, the throat should be enveloped in hot poultices, frequently changed, so as to hasten the formation of matter and quicken its approach to the surface. If any swelling can be detected by the side of the thyroid cartilage, it should be punctured with a small trocar without reference to the absence of fluctuation. Even if no swelling can be seen, in cases where the symp toms are very urgent and we feel strong suspicious of the formation of pus in the neighbourhood of the larynx, it is justifiable to make exploratory punctures. Some point on a line with the posterior border of the thyroid cartilage should be chosen for the operation. If the exploration be at tended by no satisfactory result, and the symptoms continue urgent, trache otomy should be performed.
At the same time every effort should be made to support the strength of the child. Port wine should be given, or the brandy-and-egg mixture ; and pounded meat made fluid with gravy or strong beef-tea, eggs and milk, etc., must be administered in suitable quantities. If the child cannot swallow, he must be fed, if possible, through a stomach-tube introduced by the nose.