STRIDOR IN CHILDREN IS BEING FOCUSED

1. LAKSHMI SASIKANTH
3rd year MBBS
STRIDOR

2. WHAT IS STRIDOR ???
 An excessively noisy , musical breathing due to upper airway
obstruction
 Its accompanied by hoarseness , brassy cough , dyspnea ,
chest retractions & restlessness
 Stridor is frequent in infants becoz :
 Small size of larynx
 Loose subcutaneous connective tissue around glottis region
 Rigid cricoid cartilage encircling the subglottic zone
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3. Relationship of stridor to the respiratory cycle often provides a clue to its
etiology :
INSPIRATORY
EXPIRATORY
BIPHASIC
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5. ACUTE STRIDOR
 Acute upper airway obstruction occurring in the region of
glottis which is produced by inflammation & oedema
 Maybe life threatening
 Obstruction can be
• Supraglottic as in epiglottitis
• subglottic as in infectious croup
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6. CHRONIC STRIDOR
Congenital laryngeal stridor
Congenital laryngeal or
tracheal stenosis or web
Laryngeal cyst or neoplasm
Neurogenic stridor Extrinsic obstruction
Miscellaneous causes:
Hydrochephalus, Downs,
micrognathia & glossoptosis ,
macroglossia &
diaphragmatic hernia
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7. INFECTIONS
 CROUP
 The term croup is used for used for a variety of conditions in
which a peculiar brassy cough is the main presenting feature
 The diseases include
 ACUTE EPIGLOTTITIS
 LARYNGITIS
 LARYNGOTRACHEOBRONCHITIS
 SPASMODIC LARYNGITIS
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8. EPIGLOTTITIS
• H.Influenzae type B – MC cause
• Starts with a minor URTI that progresses
rapidly within few hours
• High grade fever & dysphagia
• Tripod position , toxic appearing & drooling
• Frequent cough is absent
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10. LARYNGITIS & LARYNGOTRACHEOBRONCHITIS
• Infectious croup
• Viral infection with parainfluenza type 1 – MC
• Also parainfluenza types 2 & 3 , influenza virus , adenovirus
& rhinovirus
• Mild cold develops to brassy cough & mild inspiratory stridor
• Child becomes restless , tachypnoec & hypoxic
• Cyanosis appears
• As obstruction worsens breath sounds become inaudible &
stridor apparently decreases
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11. STEEPLE SIGN
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12. SPASMODIC CROUP
• Occurs between 1-3 years
• Child wakes up early in morning with brassy cough &
noisy breathing
• Recurrent episodes but complete recovery
• Cause – unknown
• Mgmt. : humidification of the child’s room
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13. MANAGEMENT
• Hospitalization
• Rapid airway management
• Intubation
• Broad spectrum antibiotics ( coamoxiclav, ceftriaxone ..)
• Rx with nebulized epinephrine
• Single i.m dose of dexamethasone
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14. OTHER INFECTIONS
BACTERIAL TRACHEITIS
RETROPHARYNGEAL ABSCESS
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15. CONGENITAL CAUSES
LARYNGOMALACIA
• MC congenital laryngeal anomaly & MC cause of infant stridor
• Inspiratory stridor – hallmark aggravated while supine or crying
• Dx : flexible endoscopy – partial collapse of flaccid supraglottic
airway with inspiration
• Its benign & resolve by 18 months
• Rx : surgical intervention in case of resp. distress
or FTT
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16. VOCAL CORD PARALYSIS
• 2nd MC congenital laryngeal anomaly
• B/L VCP – high pitched inspiratory stridor &
cyanosis
• Idiopathic or mostly iatrogenic ( Erb’s palsy of
recurrent nerve during vaginal delivery )
• U/L VCP – mild stridor &/or aspiration
• MCC-Iatrogenic injury during ligation of PDA
• Rx : tracheostomy in B/L VCP
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17. CONGENITAL SUBGLOTTIC STENOSIS
• 3rd MC congenital laryngeal anomaly
• Cause : incomplete recanalization of laryngotracheal tube
during embryonic development
• C/F : recurrent episodes of biphasic stridor (mis dx. as croup)
• Severe cases tracheostomy & surgical excision of stenosis
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18. VASCULAR RING
• Great vessel anomaly causing
compression of both trachea &
oesophagus
• C/F : stridor & dysphagia
• Rx : surgical
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19. SUBGLOTTIC HEMANGIOMA
• Benign vascular tumor present in trachea
• Biphasic stridor with barking cough
 CONGENITAL SACCULAR CYST
 LARYNGEAL WEB
 LARYNGEAL ATRESIA
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20. IATROGENIC CAUSES
ACQUIRED SUBGLOTTIC STENOSIS
• MC congenital laryngeal anomaly & MC cause of infant stridor
• Inspiratory stridor – hallmark aggravated while supine or crying
• Dx : flexible endoscopy – partial collapse of flaccid supraglottic
airway with inspiration
• Its benign & resolve by 18 months
• Rx : surgical intervention in case of resp. distress
or FTT
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22.  LARYNGEAL GRANULOMA
• Results from prolonged intubation
• Dx : Endoscopy reveals vocal cord granuloma
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23. NEOPLASMS
RECURRENT RESPIRATORY PAPPILOMA
• MC benign laryngeal TUMOR
• Presents with gradual airway obstruction
• Caused by HPV types 6 & 11
• MOT : Passage of fetus through infected birth canal
• Dx : Endoscopy – single or multiple irregular warty masses
in larynx or pharynx
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24. • Rx : CO2 laser ablation or excision of the papilloma
anti virals & interferons
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25. FOREIGN BODY ASPIRATION
• Potential cause of stridor in children
• MC are food & coins
• Urgent endoscopic visualization required
• Immediate removal by surgery
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