1983;35:538–41. A biphasic stridor suggests a glottic or subglottic lesion. Because of this, a child is more likely to have problems with blockage of the airway. Bilateral choanal atresia is a life-threatening condition and a well-recognized cause of airway obstruction and respiratory distress in the newborn. Russell KE, Handler SD. Orenstein DM. A laryngeal web, cyst or laryngocele may present with stridor, usually at birth or soon after. The most common cause of acute stridor in childhood is laryngotracheobronchitis, or viral croup. Know why a test or procedure is recommended and what the results could mean. Baltimore: Williams & Wilkins, 1993:474–8. Handler SD. Gilbert EG, Sharief N, In: Fleisher GR, Ludwig S, eds. This is the most common laryngeal neoplasm in children and usually results from vertical transmission of human papillomavirus at birth. Symptoms are characteristically worse at night and are aggravated by agitation and crying. / Vol. He or she will give your child a physical exam. Cogbill TH, Nelson Textbook of pediatrics. In this case laryngomalacia. Characteristically, the onset of stridor is sudden but without the expected amount of distress. Croup Viral laryngotracheitis (croup) is by far the most common cause of acute stridor in febrile children. This can be done by endotracheal intubation. A two-year-old child with a cystic hygroma on the left side of the neck. It will also depend on how severe the condition is. The upper airway in a child is shorter and narrower than that of an adult. Clinically, a thyroglossal cyst presents as a smooth, discrete mass in the midline of the neck anywhere from just above the hyoid bone to the thyroid gland. Hypertrophic Tonsils/Adenoids. Clin Pediatr. Some common causes of stridor in children are infections and defects in the child’s nose, throat, … Want to use this article elsewhere? The child may prefer to keep the neck hyperextended. Int J Pediatr Otorhinolaryngol. 3. There are many causes of stridor. The stridor is biphasic and exaggerated by crying or straining as the lesion tends to become engorged.8. If your child has a follow-up appointment, write down the date, time, and purpose for that visit. Stridor may be caused by emotional stress or it may be a manifestation of a conversion disorder. Gastrografin should be used as the contrast medium if tracheoesophageal fistula is suspected. The healthcare provider will ask about your child’s symptoms and health history. Bacterial Tracheitis. J Fam Pract. The condition is caused most commonly by parainfluenza virus, but it can also be caused by influenza virus types A or B, respiratory syncytial virus and rhinoviruses.4 Croup usually occurs in children six months to six years of age, with a peak incidence in the second year of life. Figure 3 presents an algorithm helpful in evaluating stridor in children. email@example.com for copyright questions and/or permission requests. This content is owned by the AAFP. Stridor. Laryngeal lesions often result in voice changes. 1996;43:1413–27. A newborn infant with Pierre-Robin syndrome. Stridor in the infant and child. Simon NP. Acute Spasmodic Laryngitis (Spasmodic Croup), Adapted with permission from Handler SD. Accurso FJ, Videofluoroscopy is useful in the diagnosis of tracheomalacia, foreign body aspiration and vocal cord dysfunction. The airway should be established immediately in children with severe respiratory distress. Foreign body aspiration is a common cause of acute stridor. Leung, M.B.B.S., Alberta Children's Hospital, 1820 Richmond Rd. The neck is often held in a flexed position rather than in an extended position. A laryngocele arises as a dilatation of the saccule of the laryngeal ventricle. 1. Laryngospasm (Hypocalcemic Tetany). Tunkel DE, Address correspondence to Alexander K.C. A subglottic hemangioma occurs more commonly in girls, with a female-to-male ratio of 2:1.8 The lesion is usually submucosal. Other causes include blunt trauma to the neck, high tracheotomy, cricothyrotomy, external compression of the airway and gastroesophageal reflux.7. Cystic Hygroma. / afp Stridor is a high-pitched sound that is usually heard best when a child breathes in (inspiration). 1987;16:203–6. Stridor is a noisy or high-pitched sound with breathing. Deskin RW. And tumors may also block the airways. Causes of stridor in children according to the site of obstruction are listed in Table 1. Know the reason for the visit and what you want to happen. It commonly occurs in the neck area (Figure 2). Tonsillar or adenoidal tissue may be so large that the supraglottic airway becomes obstructed. 12. Laryngotracheal stenosis is a congenital or acquired narrowing of the airway representing a continuum of disease that may affect the glottis, subglottis and trachea.7 The term “subglottic stenosis” was often used incorrectly in the past.7 The most common cause of acquired laryngotracheal stenosis is endotracheal intubation, especially in low-birth-weight infants who require prolonged intubation and ventilation. Aprenda más >. The tongue may be large enough to obstruct the hypopharynx. Supportive measures may include oxygen, humidified air, intravenous fluids, suction and aerosol treatments with steroids and beta-adrenergic drugs. The following are some of the more common causes of stridor in children: Other conditions may also cause stridor. Unilateral dysfunction may result from birth trauma, trauma during thoracic surgery or compression by mediastinal masses of cardiac, pulmonary, esophageal, thyroid or lymphoid origin. However, rigid bronchoscopy performed under general anesthesia gives a better view of the airway, especially the part below the level of the vocal cords. The sound of stridor depends on where the blockage is in your child’s upper respiratory tract. It is seen most commonly in children and rarely so in adults. Rigid bronchoscopy also allows tissue biopsy and removal of foreign bodies using forceps. This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by the AAFP. Usually multiple, papillomas most commonly occur in the vocal cords and ventricular bands but can involve any part of the larynx. The obstruction typically worsens in the supine position as gravity pulls the tongue farther back.1 Micrognathia is a classic feature of Pierre-Robin syndrome (Figure 1), Treacher Collins syndrome and Hallermann-Streiff syndrome. Although stridor may be the result of a relatively benign process, it may also be the first sign of a serious and even life-threatening disorder. Baltimore: Williams & Wilkins, 1993:474–8. Treatment may include: Call your child’s healthcare provider if your child makes a noisy or high-pitched sound while breathing. Russell KE, Vocal cord paralysis, congenital lesions such as choanal atresia, laryngeal web and vascular ring, Croup, epiglottitis, foreign body aspiration, Foreign body aspiration, infections such as croup and epiglottitis, Structural lesion such as laryngomalacia, laryngeal web or larynogotracheal stenosis, Laryngomalacia, tracheomalacia, macroglossia, micrognathia, Tracheoesophageal fistula, tracheomalacia, neurologic disorder, vascular compression, Antecedent upper respiratory tract infection, Foreign body aspiration, tracheoesophageal fistula, Epiglottitis, foreign body in esophagus, retropharyngeal or peritonsillar abscess, Laryngeal anomaly or neuromuscular disorder, Vocal cord paralysis, laryngotracheal stenosis, Birth trauma, perinatal asphyxia, cardiac problem, Cardiac disorder, hypoventilation with hypoxia, Extrinsic obstruction at or above larynx13, Arrhythmias, significant heart murmurs, abnormal heart sounds. As such, stridor demands immediate attention and thorough evaluation to uncover the precise underlying cause. Because of their smaller airways, stridor is more common in children than adults. Polysaccharide vaccine for prevention of. Angioneurotic Edema. Practitioner. Angioneurotic edema may result in acute swelling of the upper airway with resultant stridor and dyspnea.
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