Laryngeal diphtheria: still a problem

Mohamed Riyas Ali, Taorem Medhabati Devi, Ravi Meher, Jai Chand Passey, Ishwar Singh, Fathima Shereen


Background: Globally diphtheria has been showing a declining trend due to effective childhood vaccination programmes. However, inadequate healthcare delivery systems and other social factors have led to diphtheria re-emerging and remaining endemic in many regions of the world. Securing airway by emergency tracheostomy plays a pivotal role in the management of laryngeal diphtheria in addition to antitoxin.

Methods: This was a retrospective study conducted in Department of ENT, Maulana Azad Medical College from January 2015 to December 2018. The study included cases of diphtheria with stridor or impending airway obstruction. The information collected included age, gender, socioeconomic status and immunization status. The month of presentation was noted to establish the seasonal trend of the infection.  

Results: Maximum number of cases was in the age group of 3 to 9 years (62.3% of total cases). Male children predominated over female children with overall sex ratio of 3:1. Most of the cases presenting to us were partially immunized (51.8%) or unimmunized (44.6%). The maximum number of cases was reported in the month of August to November (96 out of 122 cases). Emergency tracheostomy was done in 86.9% (106 out of 122 cases).

Conclusions: Diphtheria still continues to be a major public health issue in India. Early recognition and treatment are necessary to prevent morbidities and mortalities. Tracheostomy is a speedy and efficient lifesaving procedure in the management of laryngeal diphtheria.



Diphtheria, Immunization, Stridor, Tracheostomy

Full Text:



Central Bureau of Health Intelligence (CBHI), Government of India. National Health Profile; 2005.

National Family Health Survey (NFHS-4) 2015-16, 2016. Mumbai: International Institute for Population Sciences (IIPS) and Macro International.

P.W. Alberti. Tracheostomy versus Intubation: A 19th century controversy. Ann Otol Rhinol Laryngol 1984;93.

Begg N. Diptheria - manual for the management and control of diphtheria in the European Region. WHO publication, Copenhagen; 1994.

Sharma NC, Banavalikan JN, Ranjan R, Kumar R. Bacteriological and epidemiological characteristics of diphtheria in and around Delhi-a retrospective study. Indian J Med Res. 2007;126:545-5.

Bhattacharya H. Diphtheria outbreak in a district in Meghalaya, India:an overview. Int Community Med Public Health. 2016;3(11):3282-4.

Bitragunta S, Murhekar MV, Hutin YJ. Persistence of diphtheria in Hyderabad, India, 2003-2006. Emerg Infect Dis. 2008;14:1144-6.

Havaldar PV. Diphtheria in the eighties: Experience in a South Indian District Hospital. J Indian Med Assoc. 1992;90:155-6.

Patel UV, Patel BH, Bhavsar BS, Dabhi HM, Doshi SK. A Retrospective study of diphtheria cases, Rajkot, Gujarat. Indian J of Community Medicine. 2004;29:161-3.