stridor anne aspin 2010. common causes laryngomalacia – 60% congenital subglottic stenosis vocal...
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STRIDORSTRIDOR
ANNE ASPIN 2010ANNE ASPIN 2010
Common causesCommon causes
• Laryngomalacia – 60%
• Congenital subglottic stenosis
• Vocal cord palsy - unilateral, birth trauma – temporary
• Bilateral vocal cord palsy assoc other congenital anomalies
Morimoto et al (2004)Morimoto et al (2004)
• 97 patients 1991-2001
• Laryngomalacia 32%
• Vocal cord palsy and laryngeal stenosis 22%, within 2/12, severe dyspnoea
• Haemangioma or papilloma 11%
• Cystic disease 7%
contcont
• 2 / 31 of laryngomalacia and 2 / 22 VCP had neuromuscular disorders
• 3 of VCP complicated by laryngeal stenosis
• 33 / 97 Tracheostomy
• Sometimes stridor is the only presenting symptom. Past history important
InvestigationInvestigation
• Rigid or direct microlaryngoscopy – general anaesthetic.
• Flexible fibre- optic laryngoscope, neonate awake (first line choice now)
Case historyCase history
• 6/12 girl• Fever, coughing• Inspiratory stridor• Palpable neck swelling, bulging
pharyngeal wall• Limited movement of neck• ? spasmodic croup, lymphadenitis coli• Found to be retro pharyngeal abscess
TreatmentTreatment
• Oral incision
• Drainage of abscess
• Antibiotics
Unilateral vocal cord paralysisUnilateral vocal cord paralysis
• Stridor
• Laryngospasm
• Dyspnoea
• Cause by abnormal innervation of nerve branches into adductor fibers
CasesCases
• Post Thyroid surgery
• Post cervical disc surgery
• After Herpes simplex virus with cranial nerve involvement
• Fire optic laryngoscopy showed affected vocal cord immobile
TreatmentTreatment
• Laryngeal electromyography showed evidence of reduced but intact voluntary motor conduction in thyroarytenoid muscle.
• Botox injections
ResearchResearch
Objective
• Determine stridor at rest after oral Prednisolone 1mg/kg
• And whether quick response after mild croup
MethodMethod
• Retrospective explicit chart review of children over 1 year of age admitted to a teaching hospital
• Patient demographics
• Croup scores at AE
• Duration of stridor at rest after steroids
ResultsResults
• 188 cases analysed
• Median duration at rest was 6.5 hrs, range 0.5 hrs- 82 hrs
• Patients with low score at AE recovered quicker in response to steroids, early discharge home.
Amphotericin induced stridorAmphotericin induced stridor
• Adverse effects reported Amphotericin B
• Dyspnoea
• Tachypnoea
• Bronchospasm
• Haemoptysis
• hypoxia
ObjectiveObjective
• To review mechanism of action and reports of respiratory adverse effects for Amphotericin B, the liposomal preparations for Amphotericin B and the differential diagnosis of stridor
• Medline search 1966 – 2002 looking for possible mechanisms and immunoregulatory effects of Ampho B
ResultsResults
• Amphotericin B shows increase in tumour necrosis factor alpha (TNF alpha) concentrations in macrophages.
• Induces prostaglandin E2 synthesis, increasing production of interleukin1 beta in mononuclear cells
ConclusionConclusion
• Amphotericin B induces production of TNF alpha, interferon gamma and interleukin 1 beta which have toxic effects.
Medicines for childrenMedicines for children
• Test dose infused over 30 mins – 100mcg
• Renal impairment
• Low serum pott, mag, phos
• Lft’s
• arrhythmias
• Pulmonary reactions if Amph and leucocyte Tx.
ReferencesReferences
• Bent J (2006). Pediatric laryngotracheal obstruction : current perspectives on Stridor. The Laryngoscope. 116 (7) : 1059 - 1070
• Berghout E, Peetsold M, Verboom A, Plotz F (2005). Inspiratory Stridor in a Child with a Retropharyngeal Abscess Instead of the Normally Expected Sublottic Laryngitis. Ned Tijdschr Geneeskd. 149(9):478-81 (Article in Dutch)
• Kavshal M, Upadhyay A, Aggarwal R, Deorari A (2005). Congenital Stridor Due to Bilateral Vocal Cord Palsy. Indian Journal of Paediatrics. 72(5): 443-4
• Lowery M, Greenberger P (2003) Amphotericin Induced Stridor: A Review of Stridor, Amphotericin Preparations, and their Immunoregulatory Effects. Annals of Allergy Asthma Immunology. 91(5): 460-6
References cont.References cont.• Majumdar S, Bateman N, Bull P (2006). Paediatric Stridor. Archives
of Disease in Childhood, Education Practice Edition. 91 : ep101 - ep105.
• doi 10.1136/adc.2001.066902• Morimoto N, Kawashiro N, Tsuchihashi N, Taiji H (2004). Congenital
Laryngeal Stridor. Nippon Jibinkoka Gakkai Kaiho. 107(7):690-4• Moumoulidis I, Gray R, Wilson T (2005). Outpatient Fibre-optic
Laryngscopy for Stridor in Children and Infants. European Archives Otorhinolaryngology. 262(3): 204-7
• Parker R, Powell C, Kelly A (2004). How Long Does Stridor At Rest Persist in Croup After The Administraton of Oral Prednisolone? Emergency Medicine. Vol 16, Iss 2, p135
• Tewfik T, Sobol S (2010). Congenital malformations, larynx. http://emedicine.medscape.com/article/867630-overview
• Woo P, Mangaro M (2004). Aberrant Recurrent Laryngeal Nerve Innervaton As A Cause of Stridor and Laryngospasm. Annals of Otology, Rhinology, Laryngology. 113(10): 805-8