Stridor

Question 1

Causes of stridor in adults

Answer 1

• tumour
  
  • malignant: larynx ca, hypopharynx ca
  • benign: RRP
• bilateral vocal cord immobility
• trauma: tracheal stenosis

Question 2

Larynx ca
Symptoms
Ix
Mx

Answer 2

Symptoms
- hoarseness (early)
- dysphagia, aspiration, stridor (late)
- painless neck swelling

Investigation
- direct laryngoscope and biopsy for HPE
- contrasted CT neck: staging

Management
- airway management: tracheostomy
- definitive: total laryngectomy + concurrent chemoradiotherapy

Question 3

Recurrent respiratory papillomatosis

Answer 3

Symptoms
- hoarseness (early)

Ix
- direct laryngoscope and biopsy for hpe

Mx
- airway mx: tracheostomy
- definitive: endolaryngeal debulking, hpv vaccination

Question 4

Bilateral vocal fold immobility

Answer 4

Causes
- total thyroidectomy
- stroke
- idiopathic

Mx
- airway mx: intubation
- definitive mx: laser posterior cordectomy

Question 5

Tracheal stenosis
Causes
Mx

Answer 5

Causes:
- intubation
- traumatic
- prolong >2weeks

Mx
- airway mx: tracheostomy
- definitive mx: endolaryngeal laser dilatation

Question 6

Causes of stridor in infants and children

Answer 6

• apyrexial
  
  • laryngomalacia
  • congenital: subglottic stenosis
  • foreign body
• pyrexial
  
  • acute epiglottitis
  • diphteria

Question 7

Laryngomalacia
Sx
Endoscopic sx
Ix
Mx

Answer 7

Sx
- positional stridor (worsen on supine)
- onset after birth, worsen when active
- resolves spontaneously after 2 years old

Endoscopic sx
- short AE folds
- redundant arytenoid mucosa
- omega shaped epiglottis

Ix
- awake flexible nasolaryngoscope

Mx
- airway mx: expectant
- definitive: supraglottoplasty, PAP therapy