stridor in children

STRIDOR

Dr. Yusuf Imran

Department Of Pediatrics

J.N Medical College, AMU- Aligarh

INDIA

STRIDOR Harsh, high-pitched, musical sound produced by

turbulent airflow through a partially obstructed airway

May be inspiratory, expiratory, or biphasic depending on its timing in the respiratory cycle

Inspiratory stridor suggests an extrathoracic lesion (eg, laryngeal, nasal, pharyngeal)

Expiratory stridor implies an intrathoracic lesion (eg, tracheal, bronchial)

Inspiratory Stridor

Partial supraglottic airway obstruction

Other aerodigestive tract symptoms

– suprasternal and intercostal retractions

– feeding difficulties

– muffled cry

Biphasic Stridor

Partial obstruction at the level of the glottis

Primarily inspiratory stridor

Other aerodigestive tract symptoms

– hoarseness

– aphonia

– nasal flaring

– retractions

Expiratory Stridor

Partial obstruction at the level of the subglottis or proximal trachea

Other aerodigestive tract symptoms

– xiphoid retractions

– barking cough

– nasal flaring

STRIDOR: Diagnosis

History & Examination Flexible fiberoptic laryngoscopy Direct laryngoscopy with rigid bronchoscopy Barium esophagram CT neck and chest

STRIDOR: History

Age of onset, duration, severity, and progression; precipitating events (eg, crying, feeding); positioning (eg, prone, supine, sitting); quality and nature of crying; presence of aphonia; and other associated symptoms (eg, paroxysms of cough, aspiration, difficulty feeding, drooling, sleep disordered breathing).

Perinatal history - maternal condylomata, endotracheal intubation use and duration, and presence of congenital anomalies .

Feeding and growth history, developmental history.

STRIDOR : Examination Heart and respiratory rates, cyanosis, use of accessory

muscles of respiration, nasal flaring, level of consciousness, and responsiveness.

Note the presence of infection in the oral cavity; crepitations or masses in the soft tissues of the face, neck, or chest; and deviation of the trachea

Use care when examining (especially palpating) the oral cavity or pharynx because sudden dislodgement of a foreign body or rupture of an abscess can cause further airway compromise.

STRIDOR : Examination Drooling from the mouth - suggests poor handling of

secretions, Dysphagia.

Observe the character of the cough, cry, and voice.

Careful auscultation of the nose, oropharynx, neck, and chest helps to discern the location of the stridor.

Special attention to craniofacial morphology, patency of the nares, and cutaneous hemangiomas.

CAUSES: Acute Onset Stridor

1. Laryngotracheobronchitis (croup) the most common cause of acute stridor in children 6 months to 2 years barking cough that is worst at night low-grade fever

2. Aspiration of foreign body 1-2 years food such as nuts, hot dogs, popcorn, and hard candy history of coughing and choking that precedes development of

respiratory symptoms

3. Bacterial tracheitis uncommon younger than 3 years secondary infection (most commonly due to Staphylococcus aureus)

following a viral process (commonly croup or influenza)

CAUSES: Acute Onset Stridor

4. Retropharyngeal abscess complication of bacterial pharyngitis younger than 6 years abrupt onset of high fevers, difficulty swallowing, refusal to feed, sore

throat, hyperextension of the neck, and respiratory distress

5. Peritonsillar abscess infection in the potential space between the superior constrictor

muscles and the tonsil common in adolescents and preadolescents. patient develops severe throat pain and trouble swallowing or speaking

CAUSES: Acute Onset Stridor

6. Spasmodic croup (acute spasmodic laryngitis) most commonly in children aged 1-3 years presentation may be identical to croup

7. Allergic reaction (ie, anaphylaxis) hoarseness and inspiratory stridor may be accompanied by symptoms

(eg, dysphagia, nasal congestion, itching eyes, sneezing, wheezing) that indicate the involvement of other organs

8. Epiglottitis medical emergency most commonly in children aged 2-7 years Clinically, the patient experiences an abrupt onset of high-grade fever,

sore throat, dysphagia, and drooling

CAUSES: Chronic Stridor

1. Laryngomalacia

The most common cause of inspiratory stridor in the neonatal period and early infancy

Accounts for up to 75% of all cases of stridor

Stridor may be exacerbated by crying or feeding

CAUSES: Chronic Stridor

Laryngomalacia cont…

Placing the patient in a prone position with the head up improves the stridor

Supine position worsens the stridor

Usually benign and self-limiting and improves as the child reaches age 1 year.

[Supraglottoplasty]

CAUSES: Chronic Stridor

2. Subglottic stenosis inspiratory or biphasic stridor congenital - incomplete canalization of the subglottis and cricoid rings. Acquired - is most commonly caused by prolonged intubation.

3. Vocal cord dysfunction unilateral vocal cord paralysis - congenital or secondary to trauma at

birth or time of cardiac or intrathoracic surgery bilateral vocal cord paralysis

Pt present with aphonia and a high-pitched stridor that may progress to severe respiratory distress.

It is usually associated with CNS abnormalities, such as Arnold-Chiari malformation or increased intracranial pressure

CAUSES: Chronic Stridor4. Laryngeal dyskinesia, exercise-induced laryngomalacia,

and paradoxical vocal fold motion are other neuromuscular disorders

5. Laryngeal webs

6. Laryngeal cysts

7. Laryngeal hemangiomas (glottic or subglottic) half are accompanied by cutaneous hemangiomas in the

head and neck usually regress by age 12-18 months

CAUSES : Chronic Stridor

8. Laryngeal papillomas secondary to vertical transmission of the human papilloma

virus in maternal condylomata or infected vaginal cells to the pharynx or larynx of the infant during the birth

9. Tracheomalacia most common cause of expiratory stridor

10.Tracheal stenosis secondary to extrinsic compression

MANAGEMENT

Maintain Airway Positioning of neck and body Supplemental Oxygen as needed Stridor has varied etiology hence specific

management depends on the cause.