Stridor in infancy

Boudewyns A, Claes J, Van de Heyning P. Clinical practice: an approach to stridor in infants and children. Eur J Pediatr. 2010 Feb;169(2):135-41.

“Stridor is the sound caused by abnormal air passage during breathing. The cause of stridor can be located anywhere in extrathoracic airway (nose, pharynx, larynx, and trachea) or the intrathoracic airway (tracheobronchial tree). Stridor may be acute (caused by inflammation/infection or foreign body inhalation) or chronic. It may be congenital or acquired. Stridor is a sign from which the underlying cause must be sought; it is not a diagnosis. The role of the pediatrician faced with a child or infant with noisy breathing is: (1) to determine the severity or respiratory compromise and the need for immediate intervention (to prevent respiratory failure); (2) to decide based upon history and clinical examination whether a significant lesion is suspected and, in the latter situation, to refer the child to an ENT surgeon for an upper and lower airway endoscopy; (3) to understand the consequences and management strategies of the underlying lesion and to collaborate with colleagues from related disciplines for follow-up and subsequent management of the child.”

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Zoumalan R, Maddalozzo J, Holinger LD. Etiology of stridor in infants. Ann Otol Rhinol Laryngol. 2007 May;116(5):329-34.

“Stridor is the audible symptom produced by the rapid, turbulent flow of air through a narrowed segment ofthe respiratory tract. It is the most prominent symptom of airway obstruction in infants. Since stridor is a symptom, not a diagnosis, rational management is possible only after a precise diagnosis has been established: it cannot be managed on the basis of a presumed or inferred diagnosis. This study of the causes of stridor was undertaken to identify data that facilitate determination of an accurate diagnosis and to develop a framework that is helpful in conceptualizing the problem.”

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Claes J, Boudewyns A, Deron P, Vander Poorten V, Hoeve H. Management of stridor in neonates and infants. B-ENT. 2005;Suppl 1:113-22; quiz 123-5.

“Stridor is the sound caused by abnormal air passage into the lungs and can exist in different degrees and be caused by obstruction located anywhere in the extra-thoracic (nose, pharynx, larynx, trachea) or intra-thoracic airway (tracheobronchial tree). Stridor may be congenital or acquired, acute, intermittent or chronic. Laryngotracheal inflammation (croup) is the most common cause of acute stridor. Laryngotracheomalacia is the most common cause of congenital, chronic stridor. Stridor is a clinical sign and not a diagnosis. The golden standard in the workup of stridor is an upper and lower airway endoscopy under general anaesthesia. Endoscopic examination under general anaesthesia requires a multidisciplinary approach and close cooperation between anaesthesiologist, paediatrician, ENT surgeon and nursing staff. Following this procedure, a place in the intensive care unit should be available for those cases presenting with stridor in which a definite diagnosis could not yet be established. Although important, pre-endoscopy assessment including history, physical examination and radiological examination, is only a guide to the type and degree of pathology found during endoscopy. About 1 out of 10 infants are found to have lesions in more than one anatomical site of the upper aerodigestive tract.”

Children’s and Emory users, request article from Emily Lawson.

Gatz J. Congenital stridor. Neonatal Netw. 2001 Jun;20(4):63-6.

“Causes of stridor include infection, damage, and congenital defects of the airway. [7] Stridor presenting at birth or shortly thereafter suggests a congenital etiology. Eighty-five percent of stridor cases in the first year of life can be attributed to congenital causes; of those, 65 percent are caused by laryngomalacia. [2] In addition to laryngomalacia, differential diagnoses to consider with congenital stridor include vocal cord paralysis, subglottic stenosis, subglottic hemangioma, congenital webs and atresia, and tracheal abnormalities (including those caused by external compression). [7]”

Full-text for Children’s users.

More PubMed results on stridor.

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