Evaluation of a Case of Stridor

Dept of ENT

Stridor

Noisy Respiration

Upper Airway Obstruction

Inspiratory

Expiratory
Biphasic

Anatomy

LARYNX IN CHILDREN
HIGHER LUMEN SMALLER MORE ACUTE SOFT CARTILAGES

Predictably stridor is more in children

Etiology

Congenital

Laryngomalacia Subglottic Stenosis Laryngeal Web Subglottic Haemangioma Congenital Vocal Cord Palsy

Etiology

Inflammatory

Acute Supraglottitis Acute Laryngo-Tracheo-Bronchitis Laryngeal Edema

Amyloidosis
Scleroma Neck Space Infections / Abscess

Etiology

Neoplastic

Benign

Salivary Tumors of Airway Haemangioma Adenoma Fibroma

Etiology

Neoplastic

Malignant

Squamous Cell Carcinoma Thyroid Malignancies Lymphoma

Etiology

Traumatic

Laryngo-Tracheal Trauma Iatrogenic

Thyroid Surgery Cardiothoracic Surgery Prolonged Intubation

Thermal Injury

Smoke Inhalation

Etiology

Miscellaneous

Foreign Bodies Laryngospasm Angioedema Tracheomalacia Laryngocele

HISTORY

Onset

Duration
Any Cough / Fever / Spasmodic Cough? Abnormal cry / Hoarseness

Any feeding difficulty / Dysphagia?

Aggravating / Relieving factors Related to feeding/ posture?

Weight loss

Examination

General Examination

TPR, Nutrition, Colour While Sleeping Effect of effort on stridor Note quality of cry Dysphonia? Study while feeding

Change positions and see

Chest Examination

ENT Examination

Throat

Indirect Laryngoscopy
Video Laryngoscopy

Flexible Fiberoptic Laryngoscopy

Neck Examination

Investigations

If time permits Blood Counts, ABG, Electrolytes

X-Ray Chest (PA), X-Ray Soft Tissue Neck (Lat)

Fluoroscopy Rarely, Ba Swallow, CT Scan Direct Laryngoscopy with / without anaesthesia Bronchoscopy, if reqd. Oesophagoscopy under GA

Principles of Management

ASSESSMENT OF RESPIRATORY IN SUFFICIENCY ASSESSMENT OF THE LIKELY CAUSE

ESTABLISHING AN AIRWAY TREATING THE CAUSE

Management

Stridor with pyrexia

Assess quickly Humidity, Warmth Antibiotics Steroids Inhaled / Parenteral

Racemic Epinephrine
If no improvement in few hours hospitalisation

Management

In hospital

Assessed by Paed, ENT, Anaes Investigations Direct Laryngoscopy Intubation (if reqd)

Alternative Airway

Tracheostomy Cricothyroidotomy

Treatment of specific cause

Conclusion
Airway Emergency Rapid Assessment Treatment of Cause Prevent Hypoxia Alternative Airway Constant Monitoring