Stridor

Question 1

What is stridor?

Answer 1

A high pitched noise heard on inspiration from partial obstruction at the larynx or laryngeal airways

Question 2

What is stertor?

Answer 2

An inspiratory snoring noise, coming from obstruction of the pharynx

Question 3

Children’s airways are narrower than adults, so obstruction occurs…

Answer 3

Faster and more dramatically

Question 4

What should you look for?

Answer 4

Swallowing difficulty/ drooling
Pallor/ cyanosis
Use of accessory muscles of respiration
Downward plunging of trachea with respiration (tracheal tug)

All mean impending obstruction

Question 5

What congenital causes are there?

Answer 5

Laryngomalacia
Web/stenosis
Vascular rings

Question 6

What inflammatory causes are there?

Answer 6

Laryngitis
Epiglottitis
Croup
Anaphylaxis

Question 7

What tumours can cause stridor?

Answer 7

Haemangiomas

Papillomas

Question 8

Hay kind of trauma can cause stridor?

Answer 8

Thermal or chemical, or from intubation

Question 9

What is the most common cause of stridor?

Answer 9

Laryngotracheobronchitis/ croup

Question 10

Other than stridor, what other symptoms/signs are associated with croup?

Answer 10

Barking cough
Hoarse voice
Respiratory distress

Question 11

When is croup often worse?

Answer 11

At night

Question 12

What usually causes croup?

Answer 12

Usually viral - parainfluenza, influenza

Question 13

How is croup treated?

Answer 13

Give all children with mild, moderate or severe croup a single dose of dexamethasone 0.15mg/kg

Advise parents that it is usually self limiting and resolves within 48 hours
Admit is moderate or severe croup

Question 14

Describe the severity grading of croup

Answer 14

Mild - occasional cough, no stridor at rest
Moderate - frequent cough, stridor at rest
Severe - as moderate and respiratory distress

Question 15

Is croup common?

Answer 15

Yes relatively common - affects 15% of children at some point

Question 16

What is Hoover’s sign?

Answer 16

Indrawing of the chest wall

Question 17

Describe the pathophysiology of croup

Answer 17

The viral infection leads to swelling of larynx, trachea and large bronchi due to infiltration of white blood cells. Swelling produces airway obstruction- increased work of breathing and the characteristic noisy airflow (stridor)

Question 18

What can be seen on AP CXR?

Answer 18

Steeple sign - narrowing of trachea

Is suggestive of croup but is absent in half of cases

Question 19

What is laryngomalacia?

Answer 19

The main congenital anomaly of the larynx
There is excessive collapse and indrawing of the supraglottic airways during inspiration leading to stridor, breathing and feeding difficulties.

Question 20

Is treatment usually needed for laryngomalacia?

Answer 20

85% no treatment needed at symptoms improve by 2 years old

Surgery can help in severe cases

Question 21

What does laryngomalacia literally mean?

Answer 21

Soft larynx