Stridor and drooling in infants and children

stridor in ED

1. Stridor and drooling in infants and children DR ASHMAL

2. Stridor is a high-pitched, harsh sound produced by turbulent airflowthrough a partially obstructed airway.

3. Stridor in <6 month old Mostly congenital causes 1.LARYNGOMALACIA MOST COMMON CONGENITAL LARYNGEAL ANOMALY IN CHILDREN. stridor worsens with crying and agitation but often improves with neck extension and when the child is prone. usuallymanifests shortly after birth, resolves by 18 months . Definitive diagnosis can obe made with flexible fiberoptic laryngoscopy .

4. Vocal cord paralysis congenital or acquired. Unilateral vocal cord paralysis is more common than bilateral cord paralysis and presents with feeding problems, stridor , hoarse voice, and cry changes. Children with bilateral cord paralysis often have a normal voice associatedwith stridor and dyspnea , and symptoms include cyanosis andapneic episodes. Diagnosis is by flexible nasolaryngoscopy . Endotrachealintubation can be difficult with bilateral cord paralysis, and needle cricothyroidotomy and subsequent tracheotomy may be required

5. SUB GLOTTIC STENOSIS Prolonged endotracheal intubation in premature babies is the most common cause of acquired subglottic stenosis . VASCULAR RING Congenital anomalies of the aortic arch and pulmonary artery in which anomalous vessels can compress thetrachea or esophagus.

6. HEMANGIOMA Benign congenital tumors of endothelial cells or vascular malformations that can occur anywhere on the body. . cutaneous hemangiomas new-onset stridor beginning after the firstmonth of life airway visualization through endoscopy. Although most hemangiomas spontaneously regress, large malformations and those causing significant respiratory symptoms may require treatment with β-blockers, steroids,laser , or surgery.1-3

7. STRIDOR IN CHILDREN >6 MONTHS OLD Croup Epiglottitis Bacterial tracheitis Foreign body aspiration Retropharyngeal abscess

8. CROUP most common cause of stridor outside the neonatal period, commonly affecting children6 months to 3 years old, with a peak in the second year of life. most common viruses are parainfluenza virus and rhinovirus, followed by enterovirus and respiratory syncytial virus . Clinical features Barking cough,Inspiratory stridor , Symptoms worsens at night . Agitation and crying increases night

9. DIAGNOSIS AND TREATMENT CLINICAL Radiograph - STEEPLE SIGN ( subglottic narrowing) WESTLEY SCORING SYSTEM Epinephrine .5ML/KG Corticosteroids dexamethasone of 0.6 milligram/ kgPO

10. EPIGLOTTITIS acute inflammatory condition of the epiglottis that may progress rapidly to life-threatening airway obstruction. Swelling of epiglotis with septicemia m/c organism- H Influenza tybe b Noninfectious causes,such as thermal injury, caustic burns, and direct trauma CLINICAL FEARURES Healthy childs – fever , sorethroat - toxic,difficulty in swallowing,drooling , - t ripod or sniffing position with the neckhyperextended and the chin forward to maintain the airway

11. DIAGNOSIS Radiograph- thumb sign TEREATMENT -child seated and upright in a position -Oxygen -neb with epinephrine Intubation Tracheostomy Antibiotic- 3 rd gen cephalosporins

12. AIRWAY FOREIGN BODY Consider foreign body aspiration in a young child with respiratory symptoms, regardless of the duration of symptoms, because many children may present >24 hours after foreign body aspiration sudden coughing and choking

13. 3 STAGES -Initial event - Assymptomatic - Complications; fever,hemoptysis,pneumonia DIAGNOSIS Radiograph- chest and neck More than 75% of airway foreign bodies in children < 3 years of age are radiolucent.

14. RETROPHARYNGEAL ABSCESS The retropharyngeal space occupies the space between the posterior pharyngeal wall and the prevertebral fascia and extends from the base of the skull to the level of the second thoracic vertebrae.

15. neck pain, fever, dysphagia, excessive drooling, and neck swelling DIAGNOSIS XRAY NECK,CT TREATMENT stabilize airway iv antibiotics incision and drainage

16. PERITONSILLAR ABSCES begins as a superficial infection that progresses to an accumulation of pus in a space between the tonsillar capsule and the superior constrictor muscle. sore throat, fever, chills, trismus, and voice change (“hot potato voice”). Patients will often complain of “the worst sore throat” of their life Oral antibiotics I and d

17. THANK YOU