Stridor in Paediatrics (Dr Lynn Koh & Dr Tay SY)Top 3 causes of stridor in neonates

Laryngomalacia SGS BVCP Choanal atresia SGH

Commonest 1 2 3 - -

Aggravated Activity, crying, feeding, URTI

History to ask

SPECS RVoice, hoarseness, volume of cryFB history, cardiac history, previous intubation, cyanosis, apnea, sleep, thrive, feeding (choke/regurg)

Onset Few weeks after At birth (Mild ones can present as recurrent URTI/Croup after birth)

At birth At birth Few weeks after

Association 50% of SGH will have cutaneous hemangiomas, reverse is not true

Features on scope

Accentuated omega shaped epiglottisShort AE foldsRetroflexed epiglottisInthrowing of epiglottis and AE folds during inspirationRedundant supraglottic mucosa and prominent cuneiforms

Rigid scope vs Flexi scope- Magnified view of larynx, superior image quality- Lower airway can be examined- Both diagnostic and therapeutic- Controlled environment, ventilation can be secured - Can palpate CA joint and any laryngeal cleft- Child under GA, not office procedure, VC not mobile, laryngeal dynamics cannot be assessed

Stridor in Paediatrics (Dr Lynn Koh & Dr Tay SY)

Stridor in Paediatrics (Dr Lynn Koh & Dr Tay SY)

Stridor in Paediatrics (Dr Lynn Koh & Dr Tay SY)

Stridor in Paediatrics (Dr Lynn Koh & Dr Tay SY)