Abstract
Stridor is the main symptom of upper airway obstruction in infants. It can be congenital or acquired, acute or chronic. Pathologies can be located from the nose down to the trachea. Common causes include laryngomalacia, vocal cord palsy, subglottic stenosis, tracheal anomaly, laryngeal cleft, vascular and lymphatic malformation, laryngeal papillomas, craniofacial abnormalities and even head and neck tumours. In this paper, we will discuss our approach to infants with stridor including assessment with flexible and rigid endoscopy and treatments to various conditions in a tertiary centre. Causes of stridor in infants undergoing rigid laryngotracheobronchoscopy in Queen Mary Hospital, University of Hong Kong Medical Centre between 2005 and 2011 will be retrospectively reviewed. Treatments according to various conditions will be discussed. Successful management of these neonates requires accurate diagnosis, early intervention, and multidisciplinary care by ENT surgeons, paediatricians, and paediatric anaesthetists.
Highlights
Stridor is a high-pitched sound caused by turbulent air flowing through a narrowed airway
The cricoarytenoid joints can be palpated in cases with vocal cord palsy
Rigid laryngotracheobronchoscopy is useful to further rule out secondary airway lesions (SALs) which occurred in 26% of laryngomalacia in our series
Summary
Stridor is a high-pitched sound caused by turbulent air flowing through a narrowed airway. It can be inspiratory with obstruction at the supraglottic and glottis level, biphasic with obstruction at the subglottic level, and expiratory with obstruction in the trachea. Stridor in neonates can be congenital or acquired. The commonest cause is laryngomalacia, there are secondary airway lesions (SALs) and other causes such as vocal cord palsy, subglottic stenosis, tracheal anomaly, laryngeal cleft, vascular and lymphatic malformation, laryngeal papillomas, craniofacial abnormalities, and even head and neck tumours [1, 2]. Persistent stridor deserves careful assessment and proper investigation instead of just labeling it as a benign condition such as laryngomalacia
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