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The Phenomenon of Tracheitis in Cincinnati

Monday, January 01, 0001

In 1995, physicians at Cincinnati Children's Hospital Medical Center saw an unusual surge in the number of children with bacterial tracheitis (BT), a severe infection of the trachea that usually afflicts preschool and early elementary school children. The infection is marked by thick membranes that cover the walls of the trachea, making it difficult for children to breathe.

Otolarynoglogists at Cincinnati Children's have continued to see an unusually high number of cases of tracheitis over the last 10 years. Charles Myer, MD, Michael Rutter, MD, and John Greinwald, MD, report on the Cincinnati experience with BT in the December 2004 issue of Otolaryngology Head and Neck Surgery.

Tracheitis is considered a rare condition by most practitioners. "Most ENT practitioners see a handful of cases throughout their entire career, but in Cincinnati we have continued to see a large volume of cases," Dr. Greinwald said. "We cannot explain why BT appears to be more common in the Ohio River Valley area."

An informal survey of intensive care units in Columbus, Dayton and Indianapolis did not find a high frequency of similar cases. Dr. Greinwald and his colleagues define a milder form of the more rare classical BT, which they call exudative tracheitis (ET). ET makes up about 90 percent of Cincinnati Children's tracheitis cases.

Cincinnati Children's has averaged 10 to 15 cases of tracheitis a year. Both classic BT and ET are more frequent in winter months, although there have been far fewer cases this year than expected. The reason for the fluctuation in cases is not clear. "We do seem to have bad years and good years," Dr. Greinwald said.

Tracheitis is sometimes misdiagnosed as croup, he said. Symptoms include relatively sudden onset of stridor (high pitched musical sound comparable to the sound of breathing through a straw), fever, cough and retractions. Despite the milder symptoms of ET, patients still require at least one bronchoscopic surgery to clear the trachea of the thick membranes. Most children recuperate fully after surgery and intravenous antibiotics, Dr. Greinwald said. Some children have had recurrences, but most do not suffer from any long-term side effects.

Cincinnati Children's is a 423-bed institution devoted to bringing the world the joy of healthier kids. Cincinnati Children's is dedicated to transforming the way health care is delivered by providing care that is timely, efficient, effective, family-centered, equitable and safe. It ranks third nationally among all pediatric centers in research grants from the National Institutes of Health. The Cincinnati Children's vision is to be the leader in improving child health.