Stridor

STRIDOR

DEFINATION

Stridor is noisy respiration produced by turbulent air flow through the narrowed

air passages. It may be heard during inspiration, expiration or both.

TYPES OF STRIDOR

INSPIRATORY STRIDOR – It is often produced in obstructive lesions of supraglottis or pharynx.

EXPIRATORY STRIDOR - It is produced in lesions of thoracic trachea, primary and secondary bronchi.

BIPHASIC STRIDOR - It is seen in lesions of glottis, subglottis and cervical trachea.

Types Of Stridor And Probable Site of Obstruction

Common Causes Of Stridor In Children & Infants

Diagnosis Of Stridor In Children

Diagnosis Of Stridor In Children Part - 2

MANAGEMENT

Stridor is a physical sign not a disease. Stridor is usually diagnosed on the basis of history

and physical examination, with a view to revealing the underlying problem or condition.

Attempt should always be made to discover the cause. It is important to elicit :

Time of onset Mode of onset

Duration Cyanotic spells

Aspiration or ingestion of a foreign body Laryngeal Trauma

PHYSICAL EXAMINATION

Stridor is always associated with respiratory distress. There may be recession in Suprasternal Notch, Sternum, Intercostal Spaces & Epigastrium during inspiratory efforts.

Note whether the stridor is inspiratory, expiratory or biphasic. Which indicates probable site of obstruction.

Snoring or snorting – Nasal Or Nasopharyngeal cause.

Gurgling sound and muffled voice - Pharyngeal Cause.

Horse cry or voice – Laryngeal Cause Expiratory wheeze – Bronchial

Obstruction Associated fever – Infection ex: Acute

Laryngitis

ASSOCIATED CHARACTERISTICS OF STRIDOR

RADIOGRAPHY

X-ray of chest and soft tissue neck both anteroposterior and lateral views.

Fluoroscopy to see chest movements both during inspiration and expiration.

Tomography of chest for mediastinal mass.

Angiography , if aberrant vessels are suspected

CT scan/MRI.

TREATMENT

Once the diagnosis has been made treatment of exact cause can be made.

Use of nebulized racemic adrenaline epinephrine in cases where airway edema may be the cause of the stridor.

Use of dexamethasone. Use of inhaled Heliox (70% helium, 30% oxygen);

the effect is almost instantaneous. Helium, being a less dense gas than nitrogen, reduces turbulent flow through the airways.

Some conditions (ex: epiglottitis, bacterial tracheitis) may require antibiotics, while steroids may be useful in other situations.

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