stridor the best -140717124323-phpapp02.pdf

Very very nice

1. STRIDOR
Dr. Yusuf Imran
Department Of Pediatrics
J.N Medical College, AMU-Aligarh
INDIA

2. STRIDOR
Harsh,high-pitched,musicalsoundproducedby
turbulentairflowthroughapartiallyobstructedairway
Maybeinspiratory,expiratory,orbiphasicdepending
onitstimingintherespiratorycycle
Inspiratorystridorsuggestsanextrathoraciclesion(eg,
laryngeal,nasal,pharyngeal)
Expiratorystridorimpliesanintrathoraciclesion(eg,
tracheal,bronchial)

3. Inspiratory Stridor
Partial supraglotticairway
obstruction
Other aerodigestivetract
symptoms
–suprasternal and
intercostal retractions
–feeding difficulties
–muffled cry

4. Biphasic Stridor
Partialobstructionatthe
leveloftheglottis
Primarilyinspiratorystridor
Otheraerodigestivetract
symptoms
–hoarseness
–aphonia
–nasalflaring
–retractions

5. Expiratory Stridor
Partialobstructionatthelevel
ofthesubglottisorproximal
trachea
Other aerodigestivetract
symptoms
–xiphoidretractions
–barkingcough
–nasalflaring

6. STRIDOR: Diagnosis
History&Examination
Flexiblefiberopticlaryngoscopy
Directlaryngoscopywithrigidbronchoscopy
Bariumesophagram
CTneckandchest

7. STRIDOR: History
Ageofonset,duration,severity,andprogression;precipitating
events(eg,crying,feeding);positioning(eg,prone,supine,sitting);
qualityandnatureofcrying;presenceofaphonia;andother
associatedsymptoms(eg,paroxysmsofcough,aspiration,
difficultyfeeding,drooling,sleepdisorderedbreathing).
Perinatalhistory-maternalcondylomata,endotrachealintubation
useandduration,andpresenceofcongenitalanomalies.
Feedingandgrowthhistory,developmentalhistory.

8. STRIDOR : Examination
Heartandrespiratoryrates,cyanosis,useofaccessorymuscles
ofrespiration,nasalflaring,levelofconsciousness,and
responsiveness.
Notethepresenceofinfectionintheoralcavity;crepitations
ormassesinthesofttissuesoftheface,neck,orchest;and
deviationofthetrachea
Usecarewhenexamining(especiallypalpating)theoral
cavityorpharynxbecausesuddendislodgementofaforeign
bodyorruptureofanabscesscancausefurtherairway
compromise.

9. STRIDOR : Examination
Droolingfromthemouth-suggestspoorhandlingofsecretions,
Dysphagia.
Observethecharacterofthecough,cry,andvoice.
Carefulauscultationofthenose,oropharynx,neck,andchest
helpstodiscernthelocationofthestridor.
Specialattentiontocraniofacialmorphology,patencyofthe
nares,andcutaneoushemangiomas.

10. CAUSES: Acute Onset Stridor
1.Laryngotracheobronchitis(croup)
themostcommoncauseofacutestridorinchildren
6monthsto2years
barkingcoughthatisworstatnight
low-gradefever
2.Aspirationofforeignbody
1-2years
foodsuchasnuts,hotdogs,popcorn,andhardcandy
historyofcoughingandchokingthatprecedesdevelopmentof
respiratorysymptoms
3.Bacterialtracheitis
uncommon
youngerthan3years
secondaryinfection(mostcommonlyduetoStaphylococcusaureus)
followingaviralprocess(commonlycrouporinfluenza)

11. CAUSES: Acute Onset Stridor
4.Retropharyngeal abscess
complication of bacterial pharyngitis
younger than 6 years
abrupt onset of high fevers, difficulty swallowing, refusal to feed, sore
throat, hyperextension of the neck, and respiratory distress
5.Peritonsillarabscess
infection in the potential space between the superior constrictor muscles
and the tonsil
common in adolescents and preadolescents.
patient develops severe throat pain and trouble swallowing or speaking

12. CAUSES: Acute Onset Stridor
6.Spasmodic croup (acute spasmodic laryngitis)
most commonly in children aged 1-3 years
presentation may be identical to croup
7.Allergic reaction (ie, anaphylaxis)
hoarseness and inspiratory stridor may be accompanied by symptoms (eg,
dysphagia, nasal congestion, itching eyes, sneezing, wheezing) that
indicate the involvement of other organs
8.Epiglottitis
medical emergency
most commonly in children aged 2-7 years
Clinically, the patient experiences an abrupt onset of high-grade fever,
sore throat, dysphagia, and drooling

13. CAUSES: Chronic Stridor
1.Laryngomalacia
Themostcommon causeof
inspiratorystridorintheneonatal
periodandearlyinfancy
Accountsforupto75%ofallcases
ofstridor
Stridormaybeexacerbatedby
cryingorfeeding

14. CAUSES: Chronic Stridor
Laryngomalaciacont…
Placingthepatientinapronepositionwiththeheadupimprovesthe
stridor
Supinepositionworsensthestridor
Usuallybenignandself-limitingandimprovesasthechildreachesage1
year.
[Supraglottoplasty]

15. CAUSES: Chronic Stridor
2.Subglotticstenosis
inspiratoryorbiphasicstridor
congenital-incompletecanalizationofthesubglottisandcricoidrings.
Acquired-ismostcommonlycausedbyprolongedintubation.
3.Vocalcorddysfunction
unilateralvocalcordparalysis-congenitalorsecondarytotraumaatbirth
ortimeofcardiacorintrathoracicsurgery
bilateralvocalcordparalysis
Ptpresentwithaphoniaandahigh-pitchedstridorthatmayprogressto
severerespiratorydistress.
ItisusuallyassociatedwithCNSabnormalities,suchasArnold-Chiari
malformationorincreasedintracranialpressure

16. CAUSES: Chronic Stridor
4.Laryngealdyskinesia,exercise-inducedlaryngomalacia,and
paradoxicalvocalfoldmotionareotherneuromuscular
disorders
5.Laryngealwebs
6.Laryngealcysts
7.Laryngealhemangiomas(glotticorsubglottic)
halfareaccompanied bycutaneoushemangiomas inthe
headandneck
usuallyregressbyage12-18months

17. CAUSES : Chronic Stridor
8.Laryngealpapillomas
secondarytoverticaltransmissionofthehumanpapilloma
virusinmaternalcondylomataorinfectedvaginalcellsto
thepharynxorlarynxoftheinfantduringthebirth
9.Tracheomalacia
mostcommoncauseofexpiratorystridor
10.Trachealstenosissecondarytoextrinsiccompression

18. MANAGEMENT
MaintainAirway
Positioningofneckandbody
SupplementalOxygenasneeded
Stridorhasvariedetiologyhencespecificmanagement
dependsonthecause.