Stridor is noisy breathing caused by an obstruction in the larynx or trachea (usually an inspiratory stridor) or bronchus (usually an expiratory stridor).
What are the common causes of stridor and how should they be managed?
Congenital
consider acquired subglottic stenosis in premature infants intubated for ventilation
In a neonate, congenital causes include subglottic haemangioma and vocal cord palsy.
In an infant born without stridor and developing this within three months of birth, consider laryngomalacia (or laryngotracheomalacia). This is an intrinsic immaturity of the laryngeal and tracheal skeleton, which usually matures within the second year. The soft cartilage results in the respiratory airflow causing “sucking in” of the epiglottis and trachea, typically during inspiration. The result is inspiratory stridor.
Depending on the severity, the management may be observation, aryepiglottoplasty to divide the aryepiglottic mucosa and preveent indrawing of the epiglottis, or rarely tracheotomy. In almost all cases, diagnostic microlaryngoscopy and bronchoscopy is indicated.
Inflammatory
Croup (or acute laryngotracheobronchitis) – There is a viral respiratory illness with mild fever followed by progressive stridor over a couple of days. The child is generally not very unwell, but may become exhausted from increased respiratory effort. Humidifiction, steroids and nebulised bronchodilators with general supportive measures in hospital are sometimes necessary.
Epiglottitis – This is a systemic bacterial illness. In contrast to croup, the onset is usually rapid, within hours, and the child has a high pyrexia and is systemically unwell with signs of generalised toxicity. Intubation and occasionally tracheotomy may be needed until the infection has resolved. Systemic antibiotic and fluid support is required.
With the introduction of HiB vaccine, the incidence of childhood epiglottitis has declined. As a result, most primary care practitioners are even less likely to see this condition and it should be viewed as a paediatric airway emergency.
In contrast, the condition is uncommon but still prevalent in adults. The course is equally rapid and urgent referral is necessary. Consider Candida epiglottitis in those at high risk from HIV.
ENT Doctor London is one of UK’s leading Rhinoplasty London clinics, and can be contacted on 0207 580 6970.
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05 7th, 2009 |