1.) foreign body aspiration: common in infants/toddlers
2.) airway burns/thermal epiglottitis : often by microwave-heated liquids, smoke or steam inhalation
3.) caustic burns: by ingesting caustic material, symptoms similar to epiglottitis or anaphylaxis
4.) Bacterial tracheitis: during 1st 6 years of life, usually preceded by signs of viral respiratory tract infection, cough and preference to lie flat
5.) anaphylaxis: respiratory symptoms, skin symptoms (hives, itching, swelling) and GI symptoms (vomiting, diarrhea...)
6.) epiglottitis- 2-7 years of age; can progress rapidly; respiratory distress, anxiety, and fever, with drooling, dysphagia; don't want to lay flat
1.) Laryngotracheitis (croup): accounts for 90+% of all cases of stridor in kids; 6-36 months old; starts with nasal irritation and progresses to stridor, fever, horseness, barking cough
2.) retropharyngeal abscess: 2-4 years old; starts like uncomplicated pharynigits, progresses to fever, dysphagia, drooling, unwillingness to move neck, muffled or hot potato voice, and inspiratory stridor
3.) peritonsillar abscess: 10 + years old; often complication of tonsillitis or pharyngitis; severe unilateral sore throat, fever, muffled/hot potato voice, drooling, tismus, or neck swelling
1.) laryngomolacia: most common cause of chronic extrathoracic airway obstruction in infants; neonatal-infancy; inspiratory stridor worse sleeping, feeding and supine
2.) tracheomalacia: intrinsic cartilaginous defect of trachea; expiratory stridor, croup-like cough
3.) subglottic stenosis: congenital or aquired after prolonged endotracheal intubation in infants
4.) vocal cord dysfunction or paradoxical vocal fold motion: adolescence; recurrent episodes of dyspnea & stridor; throat tightness, choking sensation, dysphonia, cough, worse with exercise
5.) vocal cord paralysis: bilateral presents with stridor and respiratory insufficiency; unilateral presents with hoarseness, risk of aspiration; can be idiopathic, congenital, trauma related (damage to recurrent laryngeal nerve)
6.) vascular ring: external compression of trachea, louder expiratory stridor; feeding difficulties
7.) bronchogenic cyst: congenital anomaly, but present 10-20 years old; recurrent coughing, wheezing, & pneumonia
8.) laryngeal malformations: congenital malformations of larynx like cysts, stenoses, clefts, and webs; feeding difficulty, failure to thrive, aspiration, respiratory distress, recurrent pulmonary infections
9.) infantile hemangiomas: risk higher if also have skin hemangioma; during 1st few months of life; respiratory distress & stridor intermittently
10.) tumor: usually intrathoracic--> expiratory stridor
1.) Thorough past medical history: infections, prematurity, complicated delivery, necessity of intubation, mechanical ventilation, surgical history, allergies/anaphylaxis, previous respiratory disease
2.) Physical exam: weight changes, skin (hemangiomas, clubbing...), size of tongue and mandible, surgical scars, neck edema, breath during rest and after activity, cyanosis, nasal flaring, retractions, tripod or sniffing (epilottitis), character and timing of stridor
3.) Airway examination via nasopharyngoscopy, laryngoscopy, and bronchoscopy
4.) Diagnostic testing
1.) laboratory testing: complete blood count, white blood cell count; viral culture for patients who may require isolation
2.) radiography: for severe or atypical feature like foreign body aspiration; need to be prepared for decompensation
3.) neck radiographs
4.) direct visualization of the larynx
5.) chest radiographs: mediastinal shift, foreign body, vascular rings, masses....
6.) other studies: CT scan, MRI, barium swallow, laryngoscopy, airway fluoroscopy
8.) Airway examination via nasopharyngoscopy, laryngoscopy, and bronchoscopy
The cause of stridor in approximately 90% of children is laryngotracheitis (Croup). Which set of symptoms would best fit the history of a 5 year-old child presenting with croup?
a. "Hot Potato" voice with severe throat pain, high fever, neck swelling, trismus, and drooling.
b. Excessive sneezing, runny nose, nagging wet cough, and expiratory wheezing sounds.
c. Twelve hours of maculo-papular rash over the face, fevers, conjunctival injection, and coryza with developing cough in the past few hours.
d. Nasal irritation and congestion, coryza, moderate fever, hoarseness, barking cough especially at night for the past 48 hours.