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Stridor in Children: By: Maj Vishal Gaurav Moderator: DR A Sethi

This document discusses stridor in children, including its definition, causes, symptoms, evaluation, and management. Stridor is a high-pitched respiratory sound caused by turbulent airflow through a partially obstructed upper airway. It can be congenital or acquired due to conditions like laryngomalacia, subglottic stenosis, or infections. Evaluation involves history, examination, and investigations like endoscopy. Management focuses on assessing respiratory status, treating the underlying cause, ensuring an open airway, and preventing hypoxia.

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Vishal Gaurav
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157 views33 pages

Stridor in Children: By: Maj Vishal Gaurav Moderator: DR A Sethi

This document discusses stridor in children, including its definition, causes, symptoms, evaluation, and management. Stridor is a high-pitched respiratory sound caused by turbulent airflow through a partially obstructed upper airway. It can be congenital or acquired due to conditions like laryngomalacia, subglottic stenosis, or infections. Evaluation involves history, examination, and investigations like endoscopy. Management focuses on assessing respiratory status, treating the underlying cause, ensuring an open airway, and preventing hypoxia.

Uploaded by

Vishal Gaurav
Copyright
© Attribution Non-Commercial (BY-NC)
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as PPT, PDF, TXT or read online on Scribd
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STRIDOR IN CHILDREN

By: Maj Vishal Gaurav Moderator: Dr A Sethi

Definition
Harsh, high-pitched, noisy respiration/musical sound produced by turbulent airflow through partially obstructed upper airway
Stridor is a symptom/sign, not a diagnosis/ disease Always indicative of airway obstruction

Stertor
Low-pitched snoring type

Further Terminology
Supraglottic obstruction:
Inspiratory stridor (high-pitched)

Extrathoracic trachea obstruction includes glottis & subglottis:


Biphasic stridor (intermediate pitch)

Intrathoracic trachea obstruction:


Expiratory stridor (wheeze)

Physics
Poiseuilles Law: Resistance inversely proportional to radius to 4th power Bernoullis Law: Pressure decreases as velocity increases, causing tendency to collapse

Anatomy
LARYNX IN CHILDREN
HIGHER LUMEN SMALLER MORE ACUTE EPIGLOTTIS: tubular & less rigid OTHER LARYNGEAL CARTILAGES: less rigid
Predictably stridor is more in children

Etiology
Congenital
Laryngomalacia Subglottic Stenosis Laryngeal Web Subglottic Haemangioma Congenital Vocal Cord Palsy

Etiology
Inflammatory
Acute Supraglottitis Acute Laryngo-Tracheo-Bronchitis

Laryngeal Edema
Amyloidosis Scleroma Neck Space Infections / Abscess

Etiology
Neoplastic
Benign
Salivary Tumors of Airway Haemangioma Adenoma

Fibroma

Etiology
Neoplastic
Malignant
Squamous Cell Carcinoma Thyroid Malignancies Lymphoma

Etiology
Traumatic
Laryngo-Tracheal Trauma Iatrogenic
Thyroid Surgery
Cardiothoracic Surgery Prolonged Intubation

Thermal Injury Smoke Inhalation

Etiology
Miscellaneous
Foreign Bodies Laryngospasm Angioedema Tracheomalacia Laryngocele

Causes of Laryngeal Inspiratory Stridor


Congenital
Web Subglottic stenosis Cyst Laryngomalacia VC Paralysis Micrognathia Cleft Larynx Lymphangioma Hemangioma

Acquired
Pyrexial
Ac Epiglottitis Ac Laryngitis Ac L-T-Bronchitis Diphtheria FB Injury Scald Papilloma

Apyrexial

Associated Symptoms
Dyspnoea
Stridor & Dyspnoea are both manifestations of airway obstruction; severity of one reflects severity of the other

Cough
Harsh, barking

Hoarseness
of speech/ cry

Deglutition
Stridor increases during feeding Stidorous infants are poor feeders

History taking
Continuous (more serious) / Intermittent Severity
loudness, cyanosis, apnoea

Age at onset
Congenital disease , manifest some time after birth (activity, first URTI)

Relationship to feeding/crying/exercise
May only be noticeable then

Physical examination
Signs of increased airway resistance
Flaring of nostrils suprasternal/intercostal/substernal recession

Tachypnoea Cyanosis Rising Pulse rate Periods of apnoea Bronchopneumonia Emphysema Bronchiectasis

Radiology
Plain lat Soft-tissue X-rays
Epiglottis Subglottis

X-ray Chest
atelectasis, consolidation, emphysema

CT scan, MRI Barium swallow

Endoscopy
All children with stridor should be endoscoped Laryngoscopy Bronchoscopy Microlaryngoscopy Flexible endoscopy problematic in infants Documentation

Evaluation of a Case of Stridor

HISTORY
Onset

Duration
Any Cough / Fever / Spasmodic Cough? Abnormal cry / Hoarseness

Any feeding difficulty / Dysphagia?


Aggravating / Relieving factors Related to feeding/ posture?

Weight loss

Examination
General Examination
TPR, Nutrition, Colour While Sleeping Effect of effort on stridor Note quality of cry Dysphonia? Study while feeding

Change positions and see

Chest Examination

ENT Examination
Throat Indirect Laryngoscopy Video Laryngoscopy Flexible Fiberoptic Laryngoscopy

Neck Examination

Investigations
If time permits

Blood Counts, ABG, Electrolytes


X-Ray Chest (PA), X-Ray Soft Tissue Neck (Lat) Fluoroscopy Rarely, Ba Swallow, CT Scan Direct Laryngoscopy with / without anaesthesia Bronchoscopy, if reqd. Oesophagoscopy under GA

Laryngomalacia
Most common congenital cause

Soft supraglottic Lx, decreased inlet


Long epiglottis, curled Short aryepiglottic folds Lx suprastructure sucked in during inspiration

Stridor increased on crying, decreased in prone position


Disappears by 3rd 4th year Inspiratory stridor without hoarseness suggestive Dx following DLS Rx - Reassurance

Laryngeal Web
Generally seen b/w the VCs anteriorly

Stridor, aphonia from birth


If big early surgery/ Laser

CONGENITAL VOCAL CORD PALSY

Congenital Subglottic Stenosis


If mild resp infections cause dyspnoea / stridor Dx if subglottic diameter is < 4 mm in a full term neonate

Subglottic Haemangioma
Increase in size at 3-6 months age HPV infection Associated cutaneous haemangioma Dx FOB or DLS Rx Endoscopic surgical removal/ Laser + Adjuvant medical therapy (prolonged steroid adm)

Laryngocoele
Dilatation of saccule of larynx extending between the thyroid cartilage and ventricle Internal/ External

Principles of Management
ASSESSMENT OF RESPIRATORY IN SUFFICIENCY ASSESSMENT OF THE LIKELY CAUSE
ESTABLISHING AN AIRWAY TREATING THE CAUSE

Management
Stridor with pyrexia
Assess quickly Humidity, Warmth Antibiotics Steroids Inhaled / Parenteral

Racemic Epinephrine
If no improvement in few hours hospitalisation

Management
In hospital
Assessed by Paed, ENT, Anaes Investigations Direct Laryngoscopy Intubation (if reqd) Alternative Airway
Tracheostomy Cricothyroidotomy

Treatment of specific cause

Conclusion
Airway Emergency Rapid Assessment Treatment of Cause Prevent Hypoxia Alternative Airway Constant Monitoring

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