Stridor

Notes

## Basic introduction

  • Stridor is a symptom of various diseases of the respiratory system (not a disease by itself)
  • It is a high-pitched breath sound as a result of turbulent air flow in the larynx or lower in the bronchial tree
  • Stridor is more common in children than in adults.

## Types of stridor

  • Inspiratory stridor in laryngeal obstruction
  • Expiratory stridor in tracheobronchial obstruction
  • Biphasic stridor in a subglottic or glottic anomaly

## Causes of acute stridora

  • Croup (most important cause in children)
  • Aspiration of foreign body
  • Anaphylaxis
  • Airway trauma
  • Psychogenic causes (rare)
  • Epiglottitis (the prevalence has been markedly reduced since the introduction of HiB vaccine)
  • Inhalation injury
  • Vocal cord dysfunction
  • Laryngospasm
  • Bacterial tracheitis
  • Retropharyngeal abscess
  • Complications during and after intubation

## Causes of chronic stridora

  • Tumors

_Laryngeal tumors

_Mediastinal tumors

  • Congenital disorders such as laryngomalacia (softening of larynx tissues above the vocal cords) and tracheomalacia
  • External compression
  • Bilateral vocal cord paralysis
  • Retrosternal thyroid
  • Bronchoscopy, laryngoscopy, prolonged intubation, neck surgery and iatrogenic causes
  • Rheumatoid arthritis accompanied by cricoarytenoid ankylosis
  • Diphtheria
  • Tuberculosis
  • Syphilis
  • Sarcoidosis
  • Wegener's granulomatosis
  • Thoracic aortic aneurysm
Symptoms
  • Stridor
Diagnosis
  • Clinical review
  • Mild cases may not require any investigations
  • Pulse oximetry
  • Arterial blood gases
  • X-rays of the neck and chest
  • CT scanning
  • MRI scanning
  • Laryngoscopy and bronchoscopy
  • Pulmonary function tests
Differential
  • Depends on the suspected cause(s)
Prevention
  • Depends on the underlying cause
Reference

1. Wareing, M. J., & Mitchell, D. (1997). Psychogenic stridor: diagnosis and management.Journal of accident & emergency medicine14(5), 330-332.

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

3. Kenyan Ministry of Health. Clinical guidelines for management and referral of common conditions at levels 4-6. Hospitals. 2009; 3:259-261.http://apps.who.int/medicinedocs/documents/s21000en/s21000en.pdf

Management
  • Depends on the underlying cause
  • The likely treatment options are:

_Intubation / tracheostomy

_Oxygen

_Corticoteroid therapy

_Nebulized racemic epinephrine

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