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Many
children make various noises while breathing. The term stridor refers to a
specific high-pitched airway noise usually noted during inspiration.
Stridor is often described as a "crowing" noise and occurs in
approximately 10% of newborn infants. Narrowing
or partial blockage of the voicebox and/or trachea results in stridorous
breathing. The most common cause of stridor in newborns is collapse of the
soft cartilages of the voicebox called laryngomalacia. The floppy walls of
the voicebox fall inward upon inspiration resulting in noisy breathing.
Other causes of newborn stridor include weakness or paralysis of one or
both vocal cord of narrowing of the upper windpipe (subglottic stenosis.) Stridor
may also occur anytime after birth. Sudden onset of stridor following a
severe coughing or choking episode may indicate that a foreign object such
as peanuts, popcorn, or small toy parts has entered the voicebox or
windpipe. Infectious causes of stridor are croup or epiglottitis. Stridor
is a symptom, which indicates narrowing of the airway. Mild or partial
obstruction of the breathing passages may result in few symptoms other
than intermittent stridor. More severe narrowing results in louder stridor
associated with signs of breathing difficulty: 1. Bluish discoloration of
lips or fingers 2. Heavy chest movements 3. In-drawing of notch at the
base or space between the ribs 4. Anxiousness or agitation 5. Inability to suck a bottle
or breast 6. Persistent cough 7. Vomiting 8. Shortness of breath The
cause of stridor is usually apparent after a thorough history and office
examination of the child. A stethoscope can be used to listen over the
voicebox and windpipe to determine the location of the noise. A flexible
telescope may be inserted through the nose or mouth to visualize the
voicebox to assess vocal cord movement and size of the airway. Floppy
tissues of the voicebox may collapse while the child is breathing or
collapse or the upper airway. Treatment
of stridor depends on the cause. Mild laryngomalacia usually persists
until 12 months of age and gradually resolves during the second year of
life. Severe laryngomalacia may be associated with the inability to feed
and breathe adequately. In
these cases, a surgical procedure can be used to release the floppy
cartilage of the larynx (epiglottoplasty) and therefore reduce collapse of
the airway. One
of the potential life threatening causes of stridor is aspiration of a
foreign object into the breathing passageways. Children ages 6 months to 4
years are at greatest risk. Often the symptoms may be quite subtle and the
condition goes undiagnosed. The diagnosis and subsequent removal of the
foreign object may require a telescopic examination of the voicebox (laryngoscopy)
and windpipe (bronchoscopy) under general anesthesia in the operating
room. Overall
the prognosis for children with stridor is very good. Most of the time the
symptoms is temporary and resolving over days to years depending on the
cause. Prompt examination and accurate diagnosis by a skilled physician is
crucial. Another
frequently diagnosed airway sound is wheezing. Stridor and wheezing are
occasionally confused. Wheezing usually originates from the lungs and is
heard during expiration. Wheezing may indicate spasm of the breathing
passageways or asthma. It is important to distinguish these two airway
sounds, as each requires different treatment. Croup
is a viral illness usually affecting children 3 months to 3 years. There
is a seasonal distribution with increased incidents in the late fall and
early winter. Croup usually follows a recent cold-like illness. A harsh
barking cough may progress to severe stridor. The diagnosis is made based
on the history and progression of the illnesses and office examination.
X-rays may be helpful. Treatment
involves cool mist or high humidity (steamy shower), fluids, and
anti-inflammatory agents such as steroids. Occasionally hospitalization is
necessary. Typical croup resolves in 3-7 days. Epiglottitis
is the most serious form of croup syndrome seen in ages 3-7. There is no
seasonal predilection. The onset of symptoms of stridor and respiratory
diseases progresses rapidly, often within hours. The infectious agent most
responsible is Hemophilus influenza Type B. Once the diagnosis is made,
steps must be taken to place an artificial airway (intubation or
tracheostomy) in the child and administer intravenous antibiotics. Once
symptoms subside, usually within 24-72 hours, the airway can be
removed. Mortality from undiagnosed epiglottitis can be as high as
50%. The information provided on
this web site is not intended to take the place of consultation with your
physician. You should always consult a physician whenever you require
diagnosis or treatment. |
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Copyright © 2008 Atlanta Children's ENT. | |
