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Defined: High-pitched noisy breathing caused by turbulence from obstruction anywhere between nasal or oral cavity to the bronchi (harsh, creaking sound)
Common in infants because of the small diameter of their airways
Subtle abnormalities can cause obstruction in newborns and infants
Inspiratory StridorTypically caused by obstruction at or above the
level of the vocal cordsExpiratory Stridor
Usually localized to the more distal tracheobronchial tree
Biphasic StridorUsually caused by obstructions at the true
vocal cords
Extrathoracic Airway ObstructionUsually present with symptoms of obstruction
Hoarseness, brassy (“Barky”) cough, or stridorPresence of agitation, air hunger, severe
retractions, cyanosis, lethargy require immediate intervention
Diagnostic evaluation should include chest and lateral neck radiographs
Congenital Laryngeal Anomalies Laryngomalacia-different types Tracheomalacia Vocal Cord Paralysis Laryngeal Clefts Vascular Rings and Slings
Infectious “Croup” (Laryngotracheitis) Epiglottitis Tracheitis
Trauma
Croup Masquerade Subglottic Hemangioma Recurrent Respiratory
Papillomatosis Post Intubation Glottic and
Subglottic Lesions Congenital Glottic and
Subglottic Stenosis Extra-Esophageal
(Gastroesophageal) Reflux Disease/Eosinophilic Esophagitis
Foreign Body Tracheal Esophageal
Laryngeal Stridor: Etiology
PresentationStaccato inspiratory stridor
Worse with exertion, feeding, cryingNoisy breathing generally begins at about 2-4 weeks
of age Endoscopic appearance
Omega epiglottisForeshortenend
aryepiglottic foldsCuneiform prolapse
Acute Laryngotracheobronchitis
Inflammation of airway is present, but edema of the subglottic space accounts for the predominant signs of airway obstruction
Common, usually between ages 6 mos to 3 yrs
Boys>girls (3:2)Seasonal – Fall and Winter
Causative Organisms75% of cases are caused by Parainfluenza
types 1, 2 & 3RSVInfluenza A, BRubeolaAdenovirusM. pneumoniaeBacterial (pseudomembranous croup)
Severe and life-threatening
Classic presentationBegins with URI symptoms (rhinorrhea, fever)Hours to days later, sxs of upper airway
obstruction developHallmark is hoarseness and a barking or
“croupy” cough (Seal bark) and inspiratory stridor
Mild-severe respiratory distressLabored breathing, marked retractions
DiagnosisBased primarily on history and examAP x-ray of the neck will show tapering
subglottic narrowing “Steeple sign”Not necessary to make diagnosis
PrognosisMost have uneventful course and improve in a
few daysRecurrence can occur in some instances
Suggests airway hyperreactivity
Supraglottitis
TRUE MEDICAL EMERGENCY!Inflammation of the epiglottis and adjacent
structuresIncidence has decreased dramatically with
HIB vaccineMost cases occur in children 1-5 yrs.Boys>Girls (only slightly)
Causative organismAlmost always H. influenzaOthers include:
S. pneumoniaeH. parainfluenzaS. aureus
PresentationProgression of illness more rapid than croupCough usually absent, high feverDrooling, apprehension, dysphagia, respiratory
distress, and toxicityResist lying downClassic “tripoding” posture
Sits upright with arms forward in front and neck extended to maximize airway caliber
“Sniffing” position – head forward, jaw thrust forward, mouth open
DiagnosisExtreme care must be taken not to agitate the
patient or irritate the airwayLateral x-ray of the neck
Thumb sign (rounded appearance of epiglottis)Thickened aryepiglotic folds
Weak, hoarse cry Mild-moderate respiratory distress
Thank you
