Stridor
Stridor: high-pitched, monophonic noise caused by turbulent airflow through a partially obstructed extrathoracic airway, heard predominantly on inspiration
Stertor: rumbling-type noise similar to snoring, which can be heard with partial airway obstruction in the oropharynx or nasopharynx
Pull in Presentation
See also Respiratory Ex
DDx
Infection ?Toxic (pale, febrile, poor perfusion)
- Tonsillitis (Bacterial/EBV)
- Retropharyngeal abscess
- Epiglottis (HiB)
- Croup (with coryza over days)
- Bacterial tracheitis (staph)
- Diphtheria
- Spasmotic croup (atopic older childrens, sudden onset / offset)
- Anaphylaxis with angioedema
- Intubation trauma / Subglottic stenosis
- Airway burns
- Haematoma
- Anterior mediastinal lymphoma
- Foreign Body
- GOR
- Hypocalcaemia
- Pseudobulbar palsy (CP)
- bilateral (CNS: myelomeningocele, Arnold-Chiari malformation, and hydrocephalus)
- high pitched inspiratory stridor
- unilateral (recurrent laryngeal nerve from lateral neck flexion during delivery, surg for TOFist/CongHD)
- weak, breathy cry / hoarse voice
- cough and aspiration
- stridor unusual
- Lingual cyst
- larygeal/oesophageal cleft
- Laryngeal web (Abnormal cry / voice)
- Laryngomalacia
- Tracheomalacia
- Subglottic haemangioma (can respond to adrenaline and steroids)
- Vascular ring
- Cystic hygroma (lymphatic malformation)
WIPE
Equipt
- NG = 1 patent choanae
- Cyanosis
- WOB
- FTT (vascular ring encircling oesophagus)
- (Temp in abscesses)
- Ex prem (ET > subglottic stenosis)
- Opitz (hypertelorism, protruding ears, cleft lip > laryngeal cleft)
- Scars (Cardiac surgery > Laryngeal nerve palsy)
Stridor
- Inspiratory = non-fixed extrathoracic
- Biphasic = non fixed tracheal or fixed (intra or extra thoracic)
- Expiratory = non fixed intrathoracic tracheal
Hyperextended neck (Supralaryngeal)
Mouth
- Micrognathia, glossoptosis, cleft (Pierre robin sequence)
- Drooling (supra laryngeal)
- Pooling of secretions (neuro)
- Mouth breather (choanal atresia)
- Fogging
- movement of mucous in nare
- Tracheostomy scar
- Tracheal deviation (intrathoracic mass)
- Neck Mass (size, shape, consistency, pulsatility, attachments, fluctuation, transillumination, auscultation, regional lymph nodes)
- Move neck side to side, flex and ext to see if changes stridor
- Pectus excavatum (chronic)
- Harrisons sulcus
- Barrel chest (CLD prem)
- IC drains (ex prem)
- Percussion of upper chest (?intrathoracic mass)
- Auscultate for associated lung/heart disease (syndromes)
- Turn prone (laryngomalacia > stridor improves prone)
- Haemangioma
- Spinal dysraphism > Arnold chiari > brain stem disfunction > vocal cord palsy
Now unpleasent
Mouth
- Suck (bulbar dysfunction CP)
- Cleft
- Swelling (mucous retention cyst, abcess, tumour)
- Gag (bulbar dysfunction CP)
- NG if failed fog test
If time look for extra features of previously identified syndrome/disease
ie focused
Dysmorphology Ex
Neurology Ex
Ix
Lateral airway
CXR
Nasendoscopy
Bronchoscopy if
- persists for 18months
- Dx is in doubt
- Failure to thrive (?vascular ring compressing oesophagus as well)
- Apnoea or cyanosis
Rx
Intubation in OT
- ENT in case Tracheostomy
Dexamethasone
Adrenaline Neb