17 stridor
TRANSCRIPT
Stridor
“Harsh, usually high pitched, turbulent sound due to partial obstruction in the larynx/ tracheo-bronchial tree and is usually associated with dyspnoea”.
Other types of noisy breathingStertor: Harsh, low-pitched turbulent
sound during respiration due to partial obstruction proximal to the larynx and may be associated with dyspnoea
Snoring: Same+ only during sleepApnea: Cessation of breathingSleep apnea syndrome: >30 apnea
episodes during 8 hours of sleep
Stridor: Things to knowTypesPitchSite of obstructionSeverityCauses
Types Inspiratory (croup)
Glottic Supraglottic Hypopharynx
Expiratory (wheeze) Distal trachea Bronchi
Biphasic Subglottic Proximal trachea
Severity Mild
Only on unaccustomed exertion Deep breathing
Moderate On minimal exertion Not able to do day-to-day activities
Severe Even at rest Accessory muscles are active Recession Features of hypoxemia like tachycardia, tachypnoea,
cyanosis, irritability and restlessness
PitchLow pitch
ProximalHigh
Distal
Site of obstruction
TypePitchAssociated symptomsExamples: Hoarseness: Larynx Dysphagia/ FB sensation in throat:
Hypopharynx Hot-potato voice: Supraglottic/ oropharynx
Etiology in children
S trid or in ch ild ren
L aryn g om alac iaC ys ts
Tu m orsS ten os is
C on g en ita l
P yrexia lIn fec tive cau se
A p yrexia lTrau m a/ F B
Tu m orN eu ro log ica l, e tc .
A cq u ired
CongenitalProximal to larynx
Nose: Choanal atresia Tongue: Macroglossia, haemangioma,
lymphangioma, lingual thyroid, etc. Mandible: Micrognathia
Laryngeal Supraglottic: LARYNGOMALACIA, cysts,
tumors Glottic: Webs, palsy, cyst Subglottic: Stenosis, tumors
Tracheobronchial Vascular loops T.E.Fistula Mediastinal congenital tumors Atresia, stenosis
Aquired
INFECTIVEAcute epiglottitisAcute laryngo-tracheo-bronchitisLaryngeal diphtheriaLaryngeal odema secondary to quinsy,
acute tonsillitis, ludwig’s angina, retro/ parapharyngeal abscess, etc.
TRAUMATICFB in upper aero-digestive tractThermalChemicalPhysical- RTARadiation
TUMORSJuvenile laryngeal papillomatosisChondromaThymomaCystic hygroma
OTHERSNeurological: Bil. VC palsyAllergy: Angioneurotic odemaLaryngismus stridulusTetanyTetanus
ETIOLOGY IN ADULTS Trauma: Laryngotracheal trauma,
laryngotracheal stenosis-RTA/ iatrogenic, FB Tumor: Larynx, pharynx, trachea, bronchus,
esophagus, thyroid, any neck/ mediastinal mass Ca. Larynx Ca. Hypopharynx
Infection: TB laryngitis, neck space infections Allergy: Angioneurotic odema Neurological: Bilateral abductor palsy
Post thyroidectomy/ CTS
EvaluationObjectives Site Severity Cause Best way to secure the airway
Methods History Clinical examination Investigations
First aid management as you evaluate Hospitalize/ early referral
History Onset: Congenital/ later, How? Duration:
Short- inflammatory/ traumatic Moderate- Malignancy Long-Benign, VC palsy
Progression Fever +/- Voice Feeding FB/ trauma/ corrosive poisoning Cyanotic speels Choking spells at night Relation to posture Aspiration Other throat/ neck/ chest symptoms
Clinical examination Type Severity Systemic features of infection Postural relation Sequential auscultation Complete ENT, neck and RS examination ILS- done with caution/ contraindicated in
moderate-severe stridor Voice/ cry
InvestigationsRadiography Plain X-ray neck AP/ lateral Chest X-ray- PA/ lateral Barium swallow CT scan- neck/ mediastinum Angiography
Endoscopy Rigid/ flexible Laryngoscope- Caution: Can give
rise to laryngospasm Rigid/ flexible Bronchoscope- after securing airway
TreatmentConservative IntubationCricothyroidotomyTracheostomy
Conservative Antibiotics- parenteral Steroids- parenteral and high dose Humidification Mucolytics O2 administration IV fluids Feeding Positioning SOS bronchodilators NO SEDATION
Intubation ADVANTAGES Easy and quick in
some cases
DISADVANTAGES Difficult intubation Prolonged
intubation- stenosis Morbid RT feeds Difficult to maintain Tracheo-bronchial
toilet- difficult Airway resistance
and deadspace- increased
Tracheostomy
ADVANTAGES By pass Prolonged periods Maintainance easy Morbidity: less Airway resistance
reduced Dead space reduced Tracheobronchial
toilet better Swallow
DISADVANTAGES More time to secure
airway Surgical procedure Major in children Difficult in children Expertise Complications
Crico-thyroidotomy Cricothyroid
membrane in the midline
Large bore needle Stab incision-
catheter
Other methodsTrans tracheal O2 administrationMini-tracheostomyPer-cutaneous tracheostomy
Multidisciplinary approachTreatment of the cause