Stridor Research Articles

Life-Threatening Stridor in Xeroderma Pigmentosum Type A

Vocal fold dystonia and total vocal fold paralysis in Xeroderma Pigmentosum Type-A (XPA) are rare clinical conditions that have been recently described in a few case reports from the Japanese literature.We report here an 11-year-old boy with XPA and seizures and a history of frequent emergency room (ER) visits to different local hospitals for recurrent inspiratory stridor that was treated as “croup” since the age of 10. The child was brought to our ER for the first time with recurrent, severe stridor and was admitted as a severe case of “croup”. He was treated for approximately two weeks with only minimal improvement. Laryngoscopy showed normal vocal cord appearance with no signs of inflammation. Shortly after discharge, he was readmitted with episodic stridor, exacerbated by irritation, excitation and post-oral feeding. The stridor subsided completely during sleep. Repeated laryngoscopy was performed to investigate other potential causes of stridor. Flexible rhino-laryngoscopy showed paradoxical vocal fold movement with glottic closure during inspiration and limited glottic opening upon expiration, which is consistent with laryngeal dystonia. This case report represents the history, physical examination and the follow-up findings in this case of XPA in a young boy with unusual presentation with stridor and rare association with vocal cord dystonia. Additionally, it illustrates the importance of proper examination and laryngoscopy in this fragile patient group for early diagnosis, proper treatment and prevention of life-threatening consequences.

Nitinol stent insertion in tracheomalacia

A 69-year-old man was admitted to our hospital with progressive dyspnoea accompanied by inspiratory stridor. He presented a history of surgical aortic valve replacement 3 years previously, complicated by prolonged...

Pediatric tracheomalacia

Tracheomalacia (TM) is defined as an increased collapsibility of the trachea due to structural anomalies of the tracheal cartilage and/or posterior membrane. Tracheomalacia has a wide range of etiologies but is most commonly present in children born with esophageal atresia and tracheal esophageal fistula. Clinical symptoms can range from minor expiratory stridor with typical barking cough to severe respiratory distress episodes to acute life-threatening events (ALTE). Although the majority of children have mild-to-moderate symptoms and will not need surgical intervention, some will need life-changing surgical treatment. This article examines the published pediatric literature on TM, discusses the details of clinical presentation, evaluation, diagnosis, and a variety of treatments.

Laryngomalacia

Laryngomalacia is the most common cause of stridor in neonates. It typically presents with inspiratory stridor and is often associated with feeding problems. Severe cases present with stridor, apnea, significant respiratory distress, and failure to thrive. Most patients are managed conservatively and can expect to see symptom resolution by 12–24 months of age. About 10% of patients require surgical treatment for their symptoms. Supraglottoplasty is the surgical technique of choice. Results of this surgery are excellent, and severe complications, such as supraglottic stenosis and aspiration, are uncommon. Supraglottoplasty is less effective in patients with significant comorbidities such as neurologic conditions and syndromes.

A systematic review of the evidence on spontaneous resolution of laryngomalacia and its symptoms

Introduction and objectivesLaryngomalacia (LM) is the most common cause of congenital stridor. Tradition holds that the majority of patients resolve spontaneously by 12–18 months of age. The objective of this study was to systematically review the literature on the spontaneous resolution of LM and/or its presenting symptoms, in otherwise healthy infants. MethodsData sources included Medline/PubMed, EMBASE, Scopus, CINAHL, Proquest, Cochrane database, Cochrane Methodology Register, Web of Science Conference Proceedings Citation Index, and ACP Journal Club. Study inclusion criteria included participants with an endoscopic diagnosis of LM, and symptoms of stridor, swallowing dysfunction, and/or snoring/sleep-disordered breathing, that documented subjective or objective resolution endpoints. Surgical series, case reports, and narrative reviews were excluded. Studies with insufficient follow-up (<3 months), and patients with comorbidities without subgroup analysis were excluded. Two independent reviewers extracted follow-up duration, rate of retention, time to resolution of LM, and method of documentation of resolution. ResultsOf the 1146 articles identified, three met inclusion/exclusion criteria (n=411 patients). All were retrospective and used stridor resolution as the only endpoint. Resolution rate was 89%, with time to resolution ranging from 4 to 42 months. Level of evidence was low, and studies suffered from lack of follow-up, and no objective endpoints. Meta-analysis was not possible. ConclusionsEndoscopic evidence of the natural history of laryngomalacia and its resolution is lacking. Low level of evidence supports that stridor and respiratory distress resolve, but the range of the time to resolution and rate of resolution is wide. Other clinical manifestations have not been studied. Prospective longitudinal trials are required to better understand the natural history.

Wire guided fibreoptic retrograde intubation in a case of glottic mass.

Wire guided fibreoptic retrograde intubation in a case of glottic mass.

A Rare Case of Vallecular Cyst

ABSTRACT Vallecular cyst is an uncommon but potentially dangerous condition causing stridor and has been associated with sudden airway obstruction resulting in death due to its anatomical location in neonates. It may also present with feeding problems resulting in failure to thrive. Endoscopic laryngoscopy is necessary to visualize vallecular cyst when suspected clinically. Other conditions leading to neonatal stridor should be ruled out, such as laryngomalacia and other laryngotracheal abnormalities. Marsupialization with a CO2 laser is the most successful treatment. We report a case of a 6-month-old male infant referred to our ear, nose and throat department of Dr. Susheela Tiwari Hospital, Government Medical College, Haldwani, for the evaluation of inspiratory stridor, feeding difficulty, suprasternal retraction, and failure to thrive. The patient was misdiagnosed and treated conservatively by a pediatrician. On rigid laryngoscopic examination, an anteriorly displacing cystic mass on the tongue base on the left side was detected. The cyst was removed intoto using bipolar cautery. Immediately after surgery, inspiratory stridor, suprasternal retraction, and feeding difficulty improved gradually. One week later, follow-up rigid laryngoscopy showed no abnormal finding except episodic influx of epiglottis. How to cite this article Gangwar A, Kuchhal V, Srivastava P. A Rare Case of Vallecular Cyst. Int J Adv Integ Med Sci 2016;1(2):88-90.

Surgical Management of Severe Case of Laryngomalacia

ABSTRACT Incidence of congenital laryngeal anomalies is between 1:10,000 and 1:50,000 births. Laryngomalacia is the most common cause of congenital stridor, characterized by partial or complete collapse of the supraglottic structures during inspiration. Patient was having inspiratory stridor at birth or immediately after birth. No active intervention is required in 90% of cases. So we are reporting this rare case that required active intervention and will also show how we managed it. How to cite this article Mahore D, Kadam S, Rane SV, Paikrao Y. Surgical Management of Severe Case of Laryngomalacia. Int J Phonosurg Laryngol 2016;6(1):47-48.

An unusual clinical course of congenital subglottic stenosis – case report

Aim: To report an unusual clinical course of an infant with congenital laryngeal stridor. Indications for endoscopic examination of airways in such cases have also been discussed. Case report: A full-term male newborn was admitted to the Department of Paediatrics because of the symptoms of acute scrotum as well as because of breathing difficulties and severe hypoxemia. Soon after surgery the child was extubated but breathing difficulties persisted. A loud inspiratory stridor together with rapid respiratory deterioration occurred. The infant was intubated and underwent mechanical ventilation again. In the following period several trials of extubation were repeatedly unsuccessful despite favourable weaning parameters. Just few hours after each trial of extubation symptoms of acute laryngotracheobronchitis were apparent. Because of extubation failure, tube dependency and persistent atypical symptoms of croup unresponsive to standard pharmacotherapy, endoscopic assessment was performed at the age of one month. Concentric central membranous subglottic stenosis was visualized. While preparing for the endoscopic laser ablation treatment, stridor was getting less pronounced. Two weeks later patient underwent endoscopy again and significant regression of subglottic membrane narrowing was documented. Planned laser intervention was canceled. At the age of four months stridor disappeared. Conclusion: Laryngomalacia is the most common cause of congenital laryngeal stridor and endoscopic evaluation is usually not indicated in such cases. However, there are other causes of congenital stridor which are not so common, including congenital subglotttic stenosis. In this case an unusual spontaneous regression of congenital membranous subglottic stenosis was reported.

Anel vascular: uma causa de desconforto respiratório neonatal frequentemente esquecida

&lt;p&gt;Objetivo: Relatar o caso de um recém-nascido com anel vascular completo causado por artéria subclávia esquerda retroesofágica em arco aórtico à direita, associado a um divertículo de Kommerell. Relato de Caso: Paciente do gênero feminino, prematuro (36 semanas e 3 dias), baixo peso (1670g), nasceu de parto via cesária e com Apgar 7/8. Ao exame físico notava-se dispneia, cianose, estridor inspiratório e sopro sistólico (2/6) em borda esternal esquerda alta. A paciente foi levada para unidade de terapia intensiva neonatal com melhora imediata do padrão respiratório e da cianose após intubação orotraqueal. A radiografia de tórax demonstrou alargamento do mediastino e arco aórtico à direita. O ecocardiograma transtorácico evidenciou: forame oval pérvio, arco aórtico à direita e tortuoso, dilatação da aorta ascendente, canal arterial pérvio grande, shunt esquerda-direita pelo septo interatrial e canal arterial e sinais de obstrução ao fluxo da artéria pulmonar direita por provável compressão vascular. A angiotomografia confirmou o anel vascular e esclareceu sua anatomia: arco aórtico à direita com artéria subclávia esquerda retroesofágica originando-se de um divertículo (Kommerell) associada à um canal arterial patente à esquerda. A artéria subclávia esquerda anômala ocasionava compressão extrínseca esofagotraqueal, do fluxo da artéria pulmonar direita e do brônquio fonte à direita. À esquerda, o grande canal arterial patente completava o anel vascular, o que ocasionou sintomas precoces. Conclusões: O anel vascular é uma malformação congênita que deve ser suspeitada em todos os pacientes com anomalias do arco aórtico que apresentam sintomas respiratórios (dispneia/estridor inspiratório e/ou sibilância crônica).&lt;/p&gt;

Stridor at Birth: Congenital Laryngeal Web

Stridor at Birth: Congenital Laryngeal Web

Eucapnic voluntary hyperpnoea and exercise-induced vocal cord dysfunction

IntroductionExercise-induced bronchoconstriction (EIB) is a common condition in endurance athletes. Exercise-induced vocal cord dysfunction (EIVCD) is a frequent confounder of EIB. The diagnosis of EIVCD may be challenging and can...

5p 欠損症候群の喉頭軟化症に舌根部甲状舌管囊胞を合併した1 例

5p 欠損症候群の喉頭軟化症に舌根部甲状舌管囊胞を合併した1 例

Acute tracheal compression in a large breed dog due to a dorsal tracheal membrane abscess

To describe a case of acute tracheal compression due to a dorsal tracheal membrane abscess in a dog. A 3-year-old intact male Bluetick Coonhound presented for evaluation of 36 hours of marked inspiratory dyspnea and stridor. A radiographic diagnosis of tracheal collapse was made on thoracic radiographs, which was confirmed to be static compression by tracheoscopy. Dorsal extraluminal tracheal compression from a fluid filled structure adjacent to the trachea was suspected based on ultrasonography. Endoscopic-guided transtracheal fine needle aspiration yielded septic suppurative inflammation. At surgery an abscess in the dorsal tracheal membrane was identified, lanced, and lavaged, which resulted in restoration of normal tracheal diameter. The dog developed bilateral pneumothorax, which was treated medically by thoracostomy tube placement and manual evacuation of the accumulated air. Postoperative radiographs also revealed evidence of pneumomediastinum. Pneumothorax and pneumomediastinum likely occurred secondary to the surgical approach, worsened by positive pressure ventilation. Cultures of the abscess isolated a nonhemolytic Streptococcus species but with no evidence of anaerobic bacteria. The dog made a full functional recovery. Tracheal compression is a rare diagnosis in dogs. To the authors' knowledge, this represents the first report of an abscess in the dorsal tracheal membrane, diagnosed by endoscopic-guided transtracheal fine needle aspiration, causing clinically relevant acute tracheal obstruction.

Diffuse, encasing lymphangioma of the supraglottis

BackgroundLymphangioma of the head and neck is considered a rare congenital tumor with the vast majority presenting before two years of age. Surgical excision and sclerosing therapy using OK-432 are recognized as effective treatment options for the majority of these lesions; however, treatment options of laryngeal lesions are less straightforward due to the risk of airway compromise and the desire to maintain the integrity of a functional larynx. We present the case of a four month old male who presented with chief complaint of inspiratory stridor after a single episode of pneumonia. His clinical presentation, flexible fiberoptic laryngoscopic examination, and operative evaluation were consistent with a lymphangioma completely encasing the epiglottis and arytenoids and isolated to the supraglottis. This report outlines our approach to workup and treatment of this rare lesion. MethodCase report of presentation, diagnosis and treatment is presented. ResultsA four-month old male presented to ENT clinic with inspiratory stridor, worsened with crying, without frank respiratory distress. History and initial examination was consistent with airway obstruction. Flexible fiberoptic laryngoscopy showed laryngomalacia as well as diffuse and symmetric supraglottic edema. Surgical evaluation identified edema limited to the supraglottis, notably along the ventral surface of the epiglottis and dorsal surface of bilateral arytenoids. Biopsies were taken and immunohistochemical staining was performed with strong positivity for D2-40 and CD31, supporting the diagnosis of isolated lymphangioma of the supraglottis. Treatment was performed through multiple point spot welding with a fiber equipped CO2 LASER (OmniGuide TM) at 5 watt continuous power. ConclusionIsolated supraglottic lymphangioma was diagnosed via direct laryngoscopy, with pathologic and immunohistochemical confirmation. Carbon dioxide laser spot welding technique was used with excellent clinical improvement in stridor. Clinical improvement is sustained after 6months follow-up.

Detection and clinical analysis of acute lower respiratory tract infection with human coronaviruses in children in Beijing area 2007-2015

To investigate human coronaviruses (HCoVs) infection in children with acute lower respiratory tract infection(ALRTI)and to explore the clinical features of ALRTI caused by HCoVs in children. Totally 4 371 children with clinical diagnosis of ALRTI during the period from March 2007 to February 2015 seen in Beijing Children's Hospital were recruited into this study. Patients were divided into 4 groups by age, including 1 890 cases in < 1 year group, 788 cases in 1-3 years group, 553 cases in 3-6 years group, 1140 cases in ≥6 years group. One nasopharyngeal aspirate specimen was collected from each patient. RT-PCR methods were applied to detect 9 common respiratory viruses including HCoVs (including HCoV-OC43, HCoV-229E, HCoV-NL63 and HCoV-HKU1), respiratory syncytial virus (RSV) and so on. Clinical features of ALRTI with single HCoVs infection were analyzed and compared with hospitalized ALRTI cases with single RSV infection in the same period. (1) Totally 2 895 cases were positive for at least one virus in this study in 4 371 ALRTI patients (positive rate 66.23%), in which 147 cases were positive for HCoVs infection (positive rate 3.36%). (2) Positive rates of HCoVs in each year from 2007 to 2014 were 6.11%, 3.79%, 4.69%, 4.31%, 2.38% 2.10%, 0.77% and 2.65%, respectively. The mean positive rates of HCoVs for each month from January to December were 2.53%, 2.12%, 3.63%, 6.68%, 1.53%, 3.77%, 3.92%, 3.00%, 2.15%, 5.26%, 3.01% and 2.80%. (3) Detection results of each subtypes of HCoVs in total 4 371 pediatric ALRTI patients were: 48 cases positive for HCoV-OC43(1.10%), 32 cases positive for HCoV-229E(0.73%), 25 cases positive for HCoV-NL63 (0.57%), 27 cases positive for HCoV-HKU1 (0.62%). (4) Positive rates of HCoVs infection in <1 year group, 1-3 years group, 3-6 years group and ≥ 6 years group were 4.13%, 5.08%, 2.71% and 1.23%, respectively. There were significant differences in positive rates of HCoV among groups (χ² = 27.218, P<0.01). (5) There were 16 hospitalized cases with single infection of HCoVs in this study, of which 12 cases were diagnosed as bronchopneumonia, 3 cases developed acute laryngeal obstruction, 2 cases had acute bronchial asthma attack. Common clinical manifestations included cough (14 cases), gasping (13 cases), dyspnea (9 cases), fever (6 cases), hoarseness (4 cases), laryngeal stridor (4 cases) and abnormality on chest X-ray (including fuzzy lung texture, patchy shadow and consolidation) (12 cases). (6) There were no significant differences in the incidence of clinical manifestations (including cough, gasping, dyspnea, fever and abnormality on chest X-ray), complications (including respiratory failure, myocardial damage, and acute bronchial asthma attack) and mechanical ventilation between hospitalized ALRTI patients with single HCoV infection and 193 patients with single RSV infection in the same period. HCoVs are pathogens of ALRTI in children, The overall positive rate of HCoVs was 3.36% in this study. The clinical manifestations and severity of ALRTI caused by single HCoVs was comparable to that of ALRTI with single RSV infection in children.

The bronchoscope diagnosis and curative effect evaluation of 24 cases of infant subglottic hemangioma

Objective To discuss the diagnosis, curative effect evaluation of infantile subglottic hemangioma through bronchoscopy, and oral Propranolol curative effect. Methods Twenty-four cases of subglottic hemangioma were retrospectively analyzed from April 2012 to March 2015 in Shandong University Qilu Children's Hospital, all cases were diagnosised by neck enhanced CT or magnetic resonance, receiving oral Propranolol treatment.Starting dose was 0.5 mg/(kg·d), 3 times per day, monitored in terms of blood pressure, blood sugar and heart rate, etc.with no bad reaction after 3 days of dosage, increased to 2.0 mg/(kg·d), 6 days later to maintain the dose for at least 6 months, with bronchoscopy follow-up visit on a regular basis.All the children received 3 to 15 months of follow-up. Results Clear diagnosis of subglottic hemangioma was made in 24 cases who received oral Propranolol treatment, and after 5-7 days symptoms such as laryngeal stridor and dyspnea were relieved to different extent.Under the bronchoscope tumors could be observed to shrink.After 6 months of oral Propranolol, 11 cases of tumors had completely faded, 13 cases of tumors had significantly reduced, laryngeal stridor and breathing difficulties were relieved.One patient with parotid gland hemangioma was also improved, 3 cases had mild bradycardia during hospital treatment, but during hospitalization and after discharge low blood pressure, hypoglycemia and other side effects were not observed. Conclusions Bronchoscopy in the diagnosis and treatment of infantile subglottic hemangioma plays an important role in the judgment of curative effect as it is both safe and reliable.Taking oral Propranolol can help to shrink tumors in a short period of time, improve the symptoms of respiratory tract obstruction, with distinct curative effect and little side effect. Key words: Hemangioma; Glottis; Infants and young child; Bronchoscopy; Propranolol

Progress of laryngeal cartilage dysplasia

Laryngeal cartilage dysplasia, also known as congenital laryngeal cartilage softening or congenital laryngeal stridor, a clinical common laryngeal disease in infant.It is often shown as airflow makes special sound through larynx or tracheal stenosis, also known as laryngeal stridor.Obstruction can be caused by airway lumen or external pressure.Airway obstruction position can be located in the nose, pharynx and larynx and trachea.Laryngeal stridor can be caused by many diseases, such as congenital laryngeal stridor, acute laryngeal, or acute laryngotracheobronchitis, respiratory tract foreign bodies, congenital laryngeal stenosis and laryngeal web, etc.The pathogenesis, pathology, clinical manifestation, diagnosis and treatment are reviewed. Key words: Laryngeal cartilage dysplasia; Laryngeal stridor; Premature infant; Low birth weight

Endoscopic surgical management of inspiratory stridor in newborns and infants

ObjectiveCompare the incidence of endoscopic surgical treatment of patients with laryngomalacia to other aerodigestive pathology who may present with similar symptoms. MethodsConsecutive case series with chart review of endoscopic surgical intervention in infants, aged 12months or less, presenting with inspiratory stridor, in the absence of syndromic condition or prior history of intubation. ResultsA total of 30 patients were identified. The average age at the time of surgical intervention was 2.7months. Endoscopic surgical management was directed at laryngomalacia (70%), vallecular cysts (23.3%), and anterior glottic webs (6.7%). All patients had nearly immediate resolution of the stridor and feeding difficulties. None required revision surgery, modified diets, or alternative means of enteric nutrition. ConclusionsLaryngomalacia was the most commonly encountered surgical indication for stridulous newborns and infants with severe symptoms. Like most previous descriptions, patients responded well to supraglottoplasty. Vallecular cysts accounted for about one-quarter of the infants treated. Clinicians should carefully consider the presence of other airway pathology, which may mimic laryngomalacia, in non-syndromic infants without a previous history of intubation. Endoscopic surgical management may be safe and effective.

Infectious upper airway obstruction

ZusammenfassungInfektiöse Erkrankungen der oberen Luftwege können besonders beim Säugling und Kleinkind zum Notfall mit partieller bis kompletter Luftwegsobstruktion und respiratorischer Insuffizienz führen. Sie erfordern ein besonnenes, ruhiges Vorgehen, manchmal aber auch ein rasches Eingreifen des erstversorgenden Mediziners. Fragen nach dem Symptombeginn, begleitender Rhinitis und Fieber sowie eine orientierende Anamnese zu möglicherweise bereits bekannten Atemwegsproblemen seit der Geburt oder in den ersten Wochen danach (z. B. kongenitale Malformationen von Larynx oder Trachea) und eine sorgfältige Beobachtung zur Einschätzung des Ausmaßes der Atemnot und Zuordnung des Atemgeräuschs zu den Atemphasen stehen am Beginn jeder Untersuchung. Die systemische Applikation von Steroiden und Inhalation von Epinephrin (Adrenalin) sind Standard bei der viralen Laryngotracheobronchitis, der häufigsten infektiösen Luftwegserkrankung mit oberer Luftwegsobstruktion. Seltene Differenzialdiagnosen wie die bakterielle Tracheitis, der Retro- und Parapharyngealabszess oder die Epiglottitis erfordern ein spezielles Management.