Presentation
We report a 47-year-old man who presented with an 8-year history of slowly progressive dyspnea and episodic stridor. [ncbi.nlm.nih.gov]
Congenital laryngeal stridor results from a congenital (present at birth) abnormality of the larynx (voice box). Stridor is a high-pitched sound that is best heard when the child breathes in. [entcolumbia.org]
Congenital laryngeal stridor is a defect that is present at birth. During fetal development, the structures in the larynx may not fully develop. [nyhq.org]
Entire Body System
- Foreign Body Aspiration
Foreign body aspiration is a common cause of stridor in children and not adults. [gradestack.com]
Foreign Body. Foreign body aspiration is a common cause of acute stridor. The peak incidence is between one and two years of age. The foreign body is usually food. A history of aspiration or choking can be obtained in 90 percent of cases. [aafp.org]
[…] most likely due to foreign body aspiration. [medicine.uiowa.edu]
Detailed history: The onset of stridor Infective or congenital aetiology History of foreign body aspiration Hoarseness of voice in the past Clinical examination: Upper airway examination for any visible obstructive lesion Examination of cardiovascular [specialist-ent.com]
- Pallor
Grade 3 : respiratory distress, irritability, pallor or cyanosis, tachycardia, and exhaustion. Grade 3 croup is an emergency that necessitates immediate treatment. Your ability to promptly recognize croup and stridor can save a child’s life. [americannursetoday.com]
Respiratoric
- Stridor
However, dystonia in the laryngeal adductor muscles has also been reported to cause laryngeal stridor. [ncbi.nlm.nih.gov]
Other characteristics of the stridor may include: The stridor changes with activity. The stridor is usually less noisy when the child is laying on his/her stomach. The stridor gets worse if the infant has an upper respiratory infection. [childrensnational.org]
Stridor is a high-pitched sound that is heard best when the child breathes in (inspiration). What causes congenital laryngeal stridor? Congenital laryngeal stridor is a defect that is present at birth. [medcentral.org]
In children, congenital laryngeal stridor is the most common cause of chronic stridor. What are the symptoms of congenital laryngeal stridor? The major symptom of this disorder is the stridor that is heard as the infant breathes. [stanfordchildrens.org]
- Aspiration
Foreign body aspiration is a common cause of stridor in children and not adults. [gradestack.com]
Aspiration in laryngeal paralysis, oesophageal atresia, laryngeal cleft, vascular ring, foreign body oesophagus. (e) Cyanotic spells. Indicate need for airway maintenance. (f) Aspiration 0r ingestion of a foreign body. (g) Laryngeal trauma. [earnosethroatclinic.blogspot.com]
Causes [ edit ] Stridor may occur as a result of: foreign bodies (e.g., aspirated foreign body, aspirated food bolus); tumor (e.g., laryngeal papillomatosis, squamous cell carcinoma of larynx, trachea or esophagus); ALL (T-cell ALL can present with mediastinal [en.wikipedia.org]
[…] most likely due to foreign body aspiration. [medicine.uiowa.edu]
- Respiratory Distress
Abstract Twelve patients with Chiari II malformation developed laryngeal stridor and respiratory distress. [ncbi.nlm.nih.gov]
Key words: bilateral recurrent laryngeal nerve palsy, respiratory distress, thyroidectomy, goiter, postoperative complication. [signavitae.com]
Important associated symptoms in all cases include cough, pain, drooling, respiratory distress, cyanosis, and difficulty feeding. [merckmanuals.com]
After trauma during birth (usually traction) or at intubation it is usually unilateral with a hoarse cry and little or no respiratory distress. [www2.health.vic.gov.au]
Presentation Progression of illness more rapid than croup Cough usually absent, high fever Drooling, apprehension, dysphagia, respiratory distress, and toxicity Resist lying down Classic “tripoding” posture Sits upright with arms forward in front [slideshare.net]
- Tachypnea
Just after infusion, she showed signs of tachypnea, bronchospasm, and laryngeal stridor. We immediately started treatment with β 2 agonist drugs. [ccforum.biomedcentral.com]
Those that do are children with tachypnea (greater than 40/min.), retractions, and cyanosis. Hospitalization usually requires supplemental measures of cold humidification, oxygen, racemic epinephrine, and occasionally steroids. [docraza.tripod.com]
Shortness of breath R06.03 Acute respiratory distress R06.09 Other forms of dyspnea R06.1 Stridor R06.3 Periodic breathing R06.4 Hyperventilation R06.5 Mouth breathing R06.8 Other abnormalities of breathing R06.81 Apnea, not elsewhere classified R06.82 Tachypnea [icd10data.com]
Case report An 80 year old patient was admitted to the emergency room of the local hospital for severe dyspnea with inspiratory stridor and tachypnea. There was thyroidectomy for massive goiter 5 weeks earlier. [signavitae.com]
Moderate distress is indicated by tachypnea, use of accessory muscles of respiration, and intercostal retractions. [merckmanuals.com]
Gastrointestinal
- Odynophagia
It usually develops suddenly with high fever, drooling, sitting forward, and odynophagia. [docraza.tripod.com]
Cardiovascular
- Cyanosis
Other symptoms may include: difficulty feeding poor weight gain choking while feeding apnea (pauses in breathing) pulling in neck and chest with each breath cyanosis (blue spells) gastroesophageal reflux (spitting, vomiting and regurgitation) Inhalation [childrenshospital.org]
Blue is generally associated with the term cyanosis. It should be noted that cyanosis is a late and unreliable sign, unless accompanied by other signs, symptoms and tests. Examine the head, neck and note signs of central cyanosis. [reocities.com]
In more severe cases of laryngomalacia, there may be: Vomiting or spitting up food (reflux) Poor weight gain Difficulty eating Choking on food Pauses in the breathing (apnea) or turning blue (cyanosis) Chest or neck sinking in when breathing (retractions [nationwidechildrens.org]
Examination When examining the infant check for: cyanosis degree of respiratory distress nature of stridor ability to feed choanal patency jaw and tongue size auscultation (transmission of breath sounds). [www2.health.vic.gov.au]
Bilateral may present with apnoea or cyanosis during feeding. It can be diagnosed by an inability to pass a nasal catheter. [patient.info]
Skin
- Sweating
I learned that the sweat test we had done was unnecessary. A sweat test is preformed on a baby's birth day. Yeah...just got a $140 bill in the mail from that sweat test. [inherrareform.weebly.com]
• Noisy breathing - stertor, stridor • Increased respiratory rate • Increased use of muscles (accessory, intercostal) • Tracheal tug • Difficulty in talking • Tachycardic • Sweating • Nasal flaring • Reduced respiratory rate (tiring) • Cyanosis, reduced [quizlet.com]
Review of systems should seek symptoms suggesting causative disorders, including heartburn or other reflux symptoms (laryngospasm); night sweats, weight loss, and fatigue (cancer); and voice change, trouble swallowing, and recurrent aspiration (neurologic [merckmanuals.com]
These respiratory effects are typically preceded by other symptoms including fear, weakness, increased sweating, sneezing, urticaria, erythema and angio-oedema. The signs of shock can then follow rapidly. [patient.info]
Constitutional symptoms associated with malignancy, such as weight loss, anorexia, fevers, and night sweats, may be present. [ahcmedia.com]
- Increased Sweating
These respiratory effects are typically preceded by other symptoms including fear, weakness, increased sweating, sneezing, urticaria, erythema and angio-oedema. The signs of shock can then follow rapidly. [patient.info]
Neurologic
- Excitement
The stridor is present during different phases of alertness — eating, sleeping, or excitement. The stridor is usually less noisy when the child is on his or her stomach. The stridor gets worse if the infant has an upper respiratory infection. [entcolumbia.org]
The stridor is present during different phases of alertness--eating, sleeping, or excitement. The stridor is usually less noisy when the child is laying on his or her stomach. The stridor gets worse if the infant has an upper respiratory infection. [nyhq.org]
The stridor is present during different phases of alertness - eating, sleeping, or excitement. The stridor is usually less noisy when the child is laying on his/her stomach. The stridor gets worse if the infant has an upper respiratory infection. [medcentral.org]
Workup
When hoarseness persists in children for more than 6 weeks, or when an acute airway obstruction does not respond to racemic epinephrine or bronchodilator therapy, careful thought should be given to the differential diagnosis, and further otolaryngology workup [consultant360.com]
The age of onset, patient history, tonal quality, and relation to the timing of the respiratory cycle is critical to the workup of a patient with stridor. [medicine.uiowa.edu]
When a tumor is suspected, obtain an MRI or CT scan, as well as a laboratory workup to screen for an oncologic process, including complete blood count (CBC), blood smear, LDH, and inflammatory markers. [ahcmedia.com]
Treatment
Although not common, some babies develop severe breathing problems which need treatment. Treatment may include medicines, a hospital stay, or surgery. Treatment will depend on your baby’s symptoms, age, and general health. [stanfordchildrens.org]
Treatment for stridor decreased the relative risk from 2.998 to 0.147. Laryngeal stridor is a common and early clinical symptom in MSA. Early treatment for stridor is advisable to reduce mortality. Copyright 2003 S. Karger AG, Basel [ncbi.nlm.nih.gov]
Treatment In most cases, this is a harmless condition that goes away on its own without treatment. It usually improves by the time the child reaches 18 months of age. [nationwidechildrens.org]
Prognosis
Treatment and prognosis Different forms of treatment have been described for laryngeal cysts, such as aspiration, marsupialisation with laser ablation and complete excision. [radiopaedia.org]
An improved understanding of this breathing disorder is essential since nocturnal stridor carries a poor prognosis (an increased risk of sudden death). [journals.plos.org]
Prognosis Most have uneventful course and improve in a few days Recurrence can occur in some instances Suggests airway hyperreactivity 12. Supraglottitis 13. TRUE MEDICAL EMERGENCY! [slideshare.net]
Kurisaki H: Prognosis of multiple system atrophy – survival time with or without tracheostomy (in Japanese). Rinsho Shinkeigaku 1999;39:503–507. [karger.com]
Prognosis The outcome of stridor depends on its cause. Death by suffocation may occur when a foreign object blocks the airway. Otherwise the outcome for most cases of stridor is good to excellent, depending on the cause. [healthofchildren.com]
Etiology
Despite reports of this disorder dating back to the mid-19th century, specific etiology and pathogenesis remain nebulous. [ncbi.nlm.nih.gov]
Etiology of stridor in the neonate, infant and child. Ann Otol Rhinol Laryngol. 1980 [medicine.uiowa.edu]
Also, viral upper respiratory infection causing acute edema frequently is the first presentation of another underlying etiology. Thus, conduct a thorough history and remember that more than one etiology may be present in any given patient. Croup. [ahcmedia.com]
This article reviews the etiology of stridor in children and suggests an approach to evaluating and managing the problem. Etiology and Clinical Manifestations Causes of stridor in children according to the site of obstruction are listed in Table 1. [aafp.org]
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 [slideshare.net]
Epidemiology
Biphasic stridor suggests subglottic or glottic obstruction. [ 1 ] Epidemiology The detailed epidemiology of stridor depends on the cause, but it is worth noting the following patterns of disease: Stridor is common in younger children with smaller airways [patient.info]
Hirayama K, Takayanagi T, Nakamura R, Yanagisawa N, Hattori T, Kita K, Yanagimoto S, Fujita M, Nagaoka M, Satomura Y, Sobue I, Iizuka R, Toyokura Y, Satoyoshi E: Spinocerebellar degenerations in Japan: A nationwide epidemiological and clinical study. [karger.com]
JUVENILE LARYNGEAL PAPILLOMATOSIS Epidemiology. Juvenile laryngeal papillomatosis--also known as juvenile respiratory papillomatosis or recurrent respiratory papillomatosis--is relatively uncommon. [consultant360.com]
BRLNP is rare, occurring in approx. 0.2% of thyroidectomies for benign thyroid affections. (2) Epidemiological data on late BRLNP after thyroidectomy is spares. [signavitae.com]
Bronchitis, Laryngotracheitis, Laryngotracheobronchitis, Laryngotracheobronchopneumonitis, Spasmodic Croup See Also Croup Score Dexamethasone in Croup Stridor Epiglottitis Bacterial Tracheitis History Word "Croup" derived from Scottish for raven's "croak" Epidemiology [fpnotebook.com]
Pathophysiology
Mor N, Simonyan K, Blitzer A: Central voice production and pathophysiology of spasmodic dysphonia. [merckmanuals.com]
Tracheomalacia Pathophysiology – expiratory collapse of the intrathoracic airway, due to defective cartilaginous support. [pedclerk.bsd.uchicago.edu]
Pathophysiologic der stenosen von kehlkopf und trachea. Archiv f�r Klinische und Experimentelle Ohren- Nasen- und Kehlkopfheilkunde, Vol. 199, Issue. 1, p. 65. CrossRef Google Scholar Martin, J. A. M. 1967. [cambridge.org]
Pathophysiology: Stridor is caused by restriction of airflow through the upper airways. As the radius of the airway deceases by a factor of 1, the area of the airway decreases by a power of 4. [medicine.uiowa.edu]
Prevention
You can also relieve GERD and LPR, and help prevent laryngospasm, by following these lifestyle tips: Avoid common heartburn triggers, such as fruit and fruit juices, caffeine, fatty foods, and peppermint. [webmd.com]
Otherwise, tracheotomy should be avoided as much as possible to prevent dissemination of the papillomas to the rest of the respiratory tract. Prevention. [consultant360.com]
Prevention Hib vaccine Getting the Haemophilus influenzae type b (Hib) vaccine prevents epiglottitis caused by Hib. In the United States, children usually receive the vaccine in three or four doses: At 2 months. At 4 months. [mayoclinic.org]
Corticosteroids to prevent postextubation upper airway obstruction: the evidence mounts. Crit Care. 2007;11(4):156. PMC2206510. [lifeinthefastlane.com]
Avoiding vocal cord stimulation when the patient is lightly anesthetized can usually prevent laryngospasm. [airwayjedi.com]