Stridor!

Stridor:

Usually an emergency.
A harsh and variable pitched vibratory sound due to partial obstruction of the upper airway.

Inspiratory with snoring is usually a nasal problem (polyp, Foreign body, atresia).

Gurgling with muffled voice is usually a pharyngeal problem (tonsils, mono, epiglottitis).

High pitched inspiratory with voice change and hoarseness is usually a laryngeal problem (Epiglottitis/ croup if febrile, laryngeal mass/ subglottic stenosis/ vocal cord paralysis if afebrile).

If both inspiratory and expiratory then usually a tracheal problem (Foreign body or mass).

If expiratory wheezes, then a bronchial problem, consider asthma or Foreign body.

Epiglottitis --> any age, + drooling, 40% afebrile, pt is sitting up and leaning forward, usually H. influenza, enlarged "thumbprint" epiglottis on X-ray, toxic looking, mild stridor. Emergency.

Croup --> 6mo-3yo, variable fever, pt is lying down, due to viral laryngospasm, X-ray with subglottic narrowing, ballooning of hypopharynx is variable, have a barking cough and hoarse voice.

Foreign Body --> age>9mo, +drooling, variable posture. Peanuts, plastic toys.

Peritonsillar Abscess --> >12yo, +drooling, high fever, upright posture with painful neck mov't. Group A Strep (GAS), stridor mild/ absent, severe pharyngitis.

Retropharyngeal Abscess --> age <6yo style="color: green;">X-ray shows enlarged retropharyngeal space.

Bacterial Tracheitis --> age 1-5yo, high fever, variable posture, H. flu/ S. aureus, X-ray shows irregular tracheal wall, toxic looking, see tracheal pseudomembrane on ETT intubation.

Congenital --> Choanal atresia in newborn, laryngeal paralysis.

Chronic Stridor --> laryngomalacia, subglottic stenosis, laryngeal lesions, vocal cord dysfunction, laryngeal papilloma, retained Foreign body.

Adults --> pharyngeal neoplasia, lingual angioedema, mucopus in larynx/trachea (with defective cough mechanism), Laryngeal inflammation (diphtheria, acute laryngitis from irritant gases, TB, syphilis, Wegener’s, sarcoid). Ankylosis of crico-arytenoid joint from RA.

Compression of larynx/ trachea (goiter, Ca, Riedel’s thyroiditis, Ca, aortic aneurysm, mediastinal growth, cellulitis, Ludwig angina, fungal infection.

Laryngeal nerve palsy, Narrowing of both main bronchi (Ca, TB, amyloid, tracheomalacia, stricture in sarcoid.

Eval in Child: take non threatening approach; observe from distance on caregiver's lap. Look for ability to drink, sustain cramming , vocalize, smile (show a toy), move, color, consolability. Don't stimulate child with stethoscope on chest.

Category: ENT Notes