Stridor (Latin for "creaking or grating noise") is a high-pitched extra-thoracic breath sound resulting from turbulent air flow in the larynx or lower in the bronchial tree. It is different from a stertor which is a noise originating in the pharynx.
Stridor
Inspiratory and expiratory stridor in a 13-month child with croup
Stridor is a physical sign which is caused by a narrowed or obstructed airway. It can be inspiratory, expiratory or biphasic, although it is usually heard during inspiration. Inspiratory stridor often occurs in children with croup. It may be indicative of serious airway obstruction from severe conditions such as epiglottitis, a foreign body lodged in the airway, or a laryngeal tumor. Stridor should always command attention to establish its cause. Visualization of the airway by medical experts equipped to control the airway may be needed.
Laryngeal edema is a common cause of stridor post extubation (occurring from pressure of the endotracheal tube on the mucosa as a result of endotracheal tube that is too large (e.g. pediatrics), cuff over inflation, and prolonged intubation times.);[2]
tumor (e.g., laryngeal papillomatosis, squamous cell carcinoma of larynx, trachea or esophagus);
ALL (T-cell ALL can present with mediastinal mass that compresses the trachea and causes inspiratory stridor)
Diagnosisedit
Stridor is mainly diagnosed on the basis of history and physical examination, with a view to revealing the underlying problem or condition.
Flexible fiberoptic bronchoscopy can also be very helpful, especially in assessing vocal cord function or in looking for signs of compression or infection.
Treatmentsedit
The first issue of clinical concern in the setting of stridor is whether or not tracheal intubation or tracheostomy is immediately necessary. A reduction in oxygen saturation is considered a late sign of airway obstruction, particularly in a child with healthy lungs and normal gas exchange. Some patients will need immediate tracheal intubation. If intubation can be delayed for a period, a number of other potential options can be considered, depending on the severity of the situation and other clinical details. These include:
Expectant management with full monitoring, oxygen by face mask, and positioning the head on the bed for optimum conditions (e.g., 45 - 90 degrees).
Use of nebulized racemic adrenaline epinephrine (0.5 to 0.75 ml of 2.25% racemic epinephrine added to 2.5 to 3 ml of normal saline) in cases where airway edema may be the cause of the stridor. (Nebulized Codeine in a dose not exceeding 3 mg/kg may also be used, but not together with racemic adrenaline [because of the risk of ventricular arrhythmias].)
Use of dexamethasone (Decadron) 4–8 mg IV q 8 - 12 h in cases where airway edema may be the cause of the stridor; note that some time (in the range of hours) may be needed for dexamethasone to work fully.
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. Always ensure an open airway.
In obese patients elevation of the panniculus has shown to relieve symptoms by 80%.
Referencesedit
^Holinger LD (1980). "Etiology of stridor in the neonate, infant and child". Ann. Otol. Rhinol. Laryngol. 89 (5 Pt 1): 397–400. doi:10.1177/000348948008900502. PMID 7436240. S2CID 20514618.
stridor, this, article, needs, additional, citations, verification, please, help, improve, this, article, adding, citations, reliable, sources, unsourced, material, challenged, removed, find, sources, news, newspapers, books, scholar, jstor, june, 2008, learn,. This article needs additional citations for verification Please help improve this article by adding citations to reliable sources Unsourced material may be challenged and removed Find sources Stridor news newspapers books scholar JSTOR June 2008 Learn how and when to remove this message Stridor Latin for creaking or grating noise is a high pitched extra thoracic breath sound resulting from turbulent air flow in the larynx or lower in the bronchial tree It is different from a stertor which is a noise originating in the pharynx Stridor source source Inspiratory and expiratory stridor in a 13 month child with croupSpecialtyOtorhinolaryngology pediatrics Stridor is a physical sign which is caused by a narrowed or obstructed airway It can be inspiratory expiratory or biphasic although it is usually heard during inspiration Inspiratory stridor often occurs in children with croup It may be indicative of serious airway obstruction from severe conditions such as epiglottitis a foreign body lodged in the airway or a laryngeal tumor Stridor should always command attention to establish its cause Visualization of the airway by medical experts equipped to control the airway may be needed Contents 1 Causes 2 Diagnosis 3 Treatments 4 References 5 External linksCauses editStridor may occur as a result of foreign bodies e g aspirated foreign body aspirated food bolus infections e g epiglottitis retropharyngeal abscess croup subglottic stenosis e g following prolonged intubation or congenital airway edema e g following instrumentation of the airway tracheal intubation drug side effect allergic reaction laryngospasm from aspiration GERD or complication of anesthesia subglottic hemangioma rare vascular rings compressing the trachea thyroiditis such as Riedel s thyroiditis vocal cord palsy tracheomalacia or tracheobronchomalacia e g collapsed trachea congenital anomalies of the airway are present in 87 of all cases of stridor in infants and children 1 vasculitis infectious mononucleosis peritonsillar abscess Laryngeal edema is a common cause of stridor post extubation occurring from pressure of the endotracheal tube on the mucosa as a result of endotracheal tube that is too large e g pediatrics cuff over inflation and prolonged intubation times 2 tumor e g laryngeal papillomatosis squamous cell carcinoma of larynx trachea or esophagus ALL T cell ALL can present with mediastinal mass that compresses the trachea and causes inspiratory stridor Diagnosis editStridor is mainly diagnosed on the basis of history and physical examination with a view to revealing the underlying problem or condition Chest and neck x rays bronchoscopy CT scans and or MRIs may reveal structural pathology Flexible fiberoptic bronchoscopy can also be very helpful especially in assessing vocal cord function or in looking for signs of compression or infection Treatments editThe first issue of clinical concern in the setting of stridor is whether or not tracheal intubation or tracheostomy is immediately necessary A reduction in oxygen saturation is considered a late sign of airway obstruction particularly in a child with healthy lungs and normal gas exchange Some patients will need immediate tracheal intubation If intubation can be delayed for a period a number of other potential options can be considered depending on the severity of the situation and other clinical details These include Expectant management with full monitoring oxygen by face mask and positioning the head on the bed for optimum conditions e g 45 90 degrees Use of nebulized racemic adrenaline epinephrine 0 5 to 0 75 ml of 2 25 racemic epinephrine added to 2 5 to 3 ml of normal saline in cases where airway edema may be the cause of the stridor Nebulized Codeine in a dose not exceeding 3 mg kg may also be used but not together with racemic adrenaline because of the risk of ventricular arrhythmias Use of dexamethasone Decadron 4 8 mg IV q 8 12 h in cases where airway edema may be the cause of the stridor note that some time in the range of hours may be needed for dexamethasone to work fully 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 Always ensure an open airway In obese patients elevation of the panniculus has shown to relieve symptoms by 80 References edit Holinger LD 1980 Etiology of stridor in the neonate infant and child Ann Otol Rhinol Laryngol 89 5 Pt 1 397 400 doi 10 1177 000348948008900502 PMID 7436240 S2CID 20514618 Wittekamp Bastiaan HJ Clinical review Post extubation laryngeal edema and extubation failure in critically ill adult patients Crit Care 2009 13 6 233 External links edit nbsp Look up stridor in Wiktionary the free dictionary Audio Breath Sounds Archived 2020 12 15 at the Wayback Machine Multiple case studies with audio files of lung sounds Stridor at eMedicine Congenital stridor at eMedicine MedlinePlus Encyclopedia Breathing sounds abnormal stridor Diseases Database DDB 27190 Stridor sounds at R A L E Lung Sounds Retrieved from https en wikipedia org w index php title Stridor amp oldid 1166476277, wikipedia, wiki, book, books, library,
