This document discusses stridor, which is a harsh sound caused by turbulent airflow through a partially obstructed airway. Stridor can be inspiratory, expiratory, or biphasic depending on where in the respiratory cycle it occurs. Inspiratory stridor suggests an upper airway obstruction while expiratory stridor implies an obstruction lower in the airway. The document outlines the characteristics, causes, diagnosis, and management of both acute and chronic stridor in children. Common causes include croup, laryngomalacia, subglottic stenosis, and foreign body aspiration. Diagnosis involves history, examination, and procedures like laryngoscopy. Management depends on the underlying cause but may include positioning, oxygen, cortic

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

2. STRIDOR
Harsh, high-pitched, musical sound produced by
turbulent airflow through a partially obstructed airway
May be inspiratory, expiratory, or biphasic depending
on its timing in the respiratory cycle
Inspiratory stridor suggests an extrathoracic lesion (eg,
laryngeal, nasal, pharyngeal)
Expiratory stridor implies an intrathoracic lesion (eg,
tracheal, bronchial)

3. Inspiratory Stridor
 Partial supraglottic airway
obstruction
 Other aerodigestive tract
symptoms
– suprasternal and
intercostal retractions
– feeding difficulties
– muffled cry

4. Biphasic Stridor
 Partial obstruction at the
level of the glottis
 Primarily inspiratory stridor
 Other aerodigestive tract
symptoms
– hoarseness
– aphonia
– nasal flaring
– retractions

5. Expiratory Stridor
 Partial obstruction at the level
of the subglottis or proximal
trachea
 Other aerodigestive tract
symptoms
– xiphoid retractions
– barking cough
– nasal flaring

6. STRIDOR: Diagnosis
 History & Examination
 Flexible fiberoptic laryngoscopy
 Direct laryngoscopy with rigid bronchoscopy
 Barium esophagram
 CT neck and chest

7. STRIDOR: History
 Age of onset, duration, severity, and progression; precipitating
events (eg, crying, feeding); positioning (eg, prone, supine, sitting);
quality and nature of crying; presence of aphonia; and other
associated symptoms (eg, paroxysms of cough, aspiration,
difficulty feeding, drooling, sleep disordered breathing).
 Perinatal history - maternal condylomata, endotracheal intubation
use and duration, and presence of congenital anomalies .
 Feeding and growth history, developmental history.

8. STRIDOR : Examination
 Heart and respiratory rates, cyanosis, use of accessory muscles
of respiration, nasal flaring, level of consciousness, and
responsiveness.
 Note the presence of infection in the oral cavity; crepitations
or masses in the soft tissues of the face, neck, or chest; and
deviation of the trachea
 Use care when examining (especially palpating) the oral
cavity or pharynx because sudden dislodgement of a foreign
body or rupture of an abscess can cause further airway
compromise.

9. STRIDOR : Examination
 Drooling from the mouth - suggests poor handling of secretions,
Dysphagia.
 Observe the character of the cough, cry, and voice.
 Careful auscultation of the nose, oropharynx, neck, and chest
helps to discern the location of the stridor.
 Special attention to craniofacial morphology, patency of the
nares, and cutaneous hemangiomas.

10. CAUSES: Acute Onset Stridor
1. Laryngotracheobronchitis (croup)
 the most common cause of acute stridor in children
 6 months to 2 years
 barking cough that is worst at night
 low-grade fever
2. Aspiration of foreign body
 1-2 years
 food such as nuts, hot dogs, popcorn, and hard candy
 history of coughing and choking that precedes development of
respiratory symptoms
3. Bacterial tracheitis
 uncommon
 younger than 3 years
 secondary infection (most commonly due to Staphylococcus aureus)
following a viral process (commonly croup or influenza)

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. Peritonsillar abscess
 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
The most common cause of
inspiratory stridor in the neonatal
period and early infancy
Accounts for up to 75% of all cases
of stridor
Stridor may be exacerbated by
crying or feeding

14. CAUSES: Chronic Stridor
Laryngomalacia cont…
Placing the patient in a prone position with the head up improves the
stridor
Supine position worsens the stridor
Usually benign and self-limiting and improves as the child reaches age 1
year.
[Supraglottoplasty]

15. CAUSES: Chronic Stridor
2. Subglottic stenosis
 inspiratory or biphasic stridor
 congenital - incomplete canalization of the subglottis and cricoid rings.
 Acquired - is most commonly caused by prolonged intubation.
3. Vocal cord dysfunction
 unilateral vocal cord paralysis - congenital or secondary to trauma at birth
or time of cardiac or intrathoracic surgery
 bilateral vocal cord paralysis
Pt present with aphonia and a high-pitched stridor that may progress to
severe respiratory distress.
It is usually associated with CNS abnormalities, such as Arnold-Chiari
malformation or increased intracranial pressure

16. CAUSES: Chronic Stridor
4. Laryngeal dyskinesia, exercise-induced laryngomalacia, and
paradoxical vocal fold motion are other neuromuscular
disorders
5. Laryngeal webs
6. Laryngeal cysts
7. Laryngeal hemangiomas (glottic or subglottic)
half are accompanied by cutaneous hemangiomas in the
head and neck
usually regress by age 12-18 months

17. CAUSES : Chronic Stridor
8. Laryngeal papillomas
secondary to vertical transmission of the human papilloma
virus in maternal condylomata or infected vaginal cells to
the pharynx or larynx of the infant during the birth
9. Tracheomalacia
most common cause of expiratory stridor
10.Tracheal stenosis secondary to extrinsic compression

18. MANAGEMENT
 Maintain Airway
 Positioning of neck and body
 Supplemental Oxygen as needed
 Stridor has varied etiology hence specific management
depends on the cause.