stridor presentation

Defined: High-pitched noisy breathing caused by turbulence from obstruction anywhere between nasal or oral cavity to the bronchi (harsh, creaking sound)

Common in infants because of the small diameter of their airways

Subtle abnormalities can cause obstruction in newborns and infants

Inspiratory StridorTypically caused by obstruction at or above the

level of the vocal cordsExpiratory Stridor

Usually localized to the more distal tracheobronchial tree

Biphasic StridorUsually caused by obstructions at the true

vocal cords

Extrathoracic Airway ObstructionUsually present with symptoms of obstruction

Hoarseness, brassy (“Barky”) cough, or stridorPresence of agitation, air hunger, severe

retractions, cyanosis, lethargy require immediate intervention

Diagnostic evaluation should include chest and lateral neck radiographs

Congenital Laryngeal Anomalies Laryngomalacia-different types Tracheomalacia Vocal Cord Paralysis Laryngeal Clefts Vascular Rings and Slings

Infectious “Croup” (Laryngotracheitis) Epiglottitis Tracheitis

Trauma

Croup Masquerade Subglottic Hemangioma Recurrent Respiratory

Papillomatosis Post Intubation Glottic and

Subglottic Lesions Congenital Glottic and

Subglottic Stenosis Extra-Esophageal

(Gastroesophageal) Reflux Disease/Eosinophilic Esophagitis

Foreign Body Tracheal Esophageal

Laryngeal Stridor: Etiology

PresentationStaccato inspiratory stridor

Worse with exertion, feeding, cryingNoisy breathing generally begins at about 2-4 weeks

of age Endoscopic appearance

Omega epiglottisForeshortenend

aryepiglottic foldsCuneiform prolapse

Acute Laryngotracheobronchitis

Inflammation of airway is present, but edema of the subglottic space accounts for the predominant signs of airway obstruction

Common, usually between ages 6 mos to 3 yrs

Boys>girls (3:2)Seasonal – Fall and Winter

Causative Organisms75% of cases are caused by Parainfluenza

types 1, 2 & 3RSVInfluenza A, BRubeolaAdenovirusM. pneumoniaeBacterial (pseudomembranous croup)

Severe and life-threatening

Classic presentationBegins with URI symptoms (rhinorrhea, fever)Hours to days later, sxs of upper airway

obstruction developHallmark is hoarseness and a barking or

“croupy” cough (Seal bark) and inspiratory stridor

Mild-severe respiratory distressLabored breathing, marked retractions

DiagnosisBased primarily on history and examAP x-ray of the neck will show tapering

subglottic narrowing “Steeple sign”Not necessary to make diagnosis

PrognosisMost have uneventful course and improve in a

few daysRecurrence can occur in some instances

Suggests airway hyperreactivity

Supraglottitis

TRUE MEDICAL EMERGENCY!Inflammation of the epiglottis and adjacent

structuresIncidence has decreased dramatically with

HIB vaccineMost cases occur in children 1-5 yrs.Boys>Girls (only slightly)

Causative organismAlmost always H. influenzaOthers include:

S. pneumoniaeH. parainfluenzaS. aureus

PresentationProgression of illness more rapid than croupCough usually absent, high feverDrooling, apprehension, dysphagia, respiratory

distress, and toxicityResist lying downClassic “tripoding” posture

Sits upright with arms forward in front and neck extended to maximize airway caliber

“Sniffing” position – head forward, jaw thrust forward, mouth open

DiagnosisExtreme care must be taken not to agitate the

patient or irritate the airwayLateral x-ray of the neck

Thumb sign (rounded appearance of epiglottis)Thickened aryepiglotic folds

Weak, hoarse cry Mild-moderate respiratory distress

Thank you