Onset Of Stridor Research Articles

Recurrent stridor in a 9-year-old child after a choking and aspiration event

This is a case report of a 9-year-old boy with new onset stridor 5 days after a choking event. Symptoms would last 5-45 minutes. His stridor was unresponsive to nebulized epinephrine but improved when he relaxed. Otlaryngology examination noted laryngeal irritation that was suggestive of gastroesophageal reflux (GER). Episodic stridor continued, despite treatment for GER, prompting hospitalization. On admission, barium swallow indicated hyperinflation of the left lung and bronchoscopy confirmed the aspiration of food. Within 12 hours of bronchoscopy, his stridor recurred. The recurrence of stridor after bronchoscopy resulted in further evaluation of his upper airway disorder. The true diagnosis was revealed during methacholine challenge. This case illustrates a unique presentation of a common upper respiratory disorder, the need for a high index of suspicion to make the diagnosis, and the importance of the multispecialty approach needed to treat patients with this disorder.

Life-threatening carotid haemorrhage following blunt trauma

We report a case of internal carotid arterial damage following blunt neck trauma. This rare mechanism of injury demands a high index of suspicion to enable prompt specialist management. A 22-year-old man presented to hospital after sustaining blunt neck trauma. Rapid onset of stridor necessitated an emergency tracheostomy. Computed tomography angiography demonstrated a tear of the right internal carotid artery, which was repaired surgically. Blunt carotid vessel injury, although rare, has a high mortality rate. Mechanisms of injury include hyperextension and contralateral neck rotation, a direct blow to the vessel, and laceration by adjacent bony structures. The 'gold standard' investigation for suspected blunt carotid vessel injury is catheter angiography, although this carries a small risk of stroke. Computed tomography angiography is a less invasive, alternative investigation which has almost equivalent accuracy. The extent of damage to the vessel wall will dictate treatment. In our literature review, we discuss the presentation, investigation and different treatment modalities available. This case highlights an unusual mechanism of carotid artery injury, with a delayed, potentially fatal presentation. Such injury demands a high index of suspicion, and confirmation with specific investigations. Management is hazardous and requires experienced personnel in all aspects of care.

Retrograde Upper Endoscopy and Endoscopic Ultrasound in Obstructive Esophageal Lesions

Purpose: Background: Severe stenotic lesions in the esophagus can impair the antegrade passage of endoscopic instruments. We report successful diagnostic retrograde upper endoscopy (UE) and endoscopic ultrasound (EUS) in two cases in which the antegrade approach failed. Case 1: An 82 year old female with a history of squamous cell carcinoma (SCC) of the esophagus had a gastrostomy (G) tube placed for nutritional support. She was treated with chemotherapy and radiation; which resulted in remission for 6 years. She presented with new onset of stridor. Computed tomography scan of the neck demonstrated a new mass arising from the proximal esophagus compressing the trachea. A tracheal stent was placed for airway palliation. Antegrade passage of the upper endoscope was not possible due to complete obstruction of the proximal esophagus. The visualized areas of esophageal mucosa appeared normal. Retrograde endoscopy of the esophagus was performed by passing a jagwire through the 20 F G tube, followed by removal of the G tube over the wire. An ultrathin upper endoscope (Olympus GIF-N180) was inserted in the G tube fistula over the jagwire. Once in the stomach the scope was advanced through the gastroesophageal junction to the esophageal lesion. Forceps biopsies obtained from the abnormal mucosa in the mid esophagus showed recurrence of the SCC. Case 2: A 59 year old female had a history of laryngeal cancer and laryngectomy complicated by tracheo-esophgeal fistula, which required several surgical interventions. During evaluation for further fistula repair, new mediastinal lymphadenopathy was found. EUS was requested for further evaluation. An UE exam showed narrowing at the level of the fistula. Despite through the scope balloon dilation up to 12 mm, the EUS scope could not be advanced beyond the proximal esophagus. Laparoscopic gastrostomy was performed to permit transgastric EUS. The linear EUS (Olympus GFUC140) scope was passed through the surgically placed gastrostomy into the stomach and was advanced to the mid esophagus. The aorto-pulomonary window revealed two round, hypoechoic lymph nodes 7 mm in size and a 2.3 cm × 1.0 cm, hypoechoic subcarinal node. EUS-guided fine needle aspiration of these lymph nodes revealed metastatic SCC of the larynx. Retrograde UE and EUS can be safely performed in the presence of obstructive esophageal lesions. This approach should be considered when antegrade endoscopy is not possible.

Laryngeal Oncocytic Cyst Presenting with an Acute Onset of Stridor

Oncocytic lesions of the larynx are rare. When they have occurred, their presentation has been varied; these tumors may be completely asymptomatic and discovered incidentally, but more commonly they present with voice alteration. We report a case of an oncocytic cyst in a patient who presented with an acute onset of stridor. We also discuss the clinical manifestations and management of laryngeal oncocytic cyst and its relevant pathologic features.

Beware of external tracheal compression in children with acute onset stridor

Beware of external tracheal compression in children with acute onset stridor

Movement artefact – A pain in the neck!

An 18-month-old child came to the Accident and Emergency department in the early hours of the morning with a brief history of sudden onset stridor and respiratory distress associated with a barking cough. This was his first hospital admission and he was a healthy child with normal development. He had been fully immunised for his age. The senior house officer in the department decided to perform a lateral cervical spine radiograph to establish the cause of stridor. It is important to note that as the history was typical of viral croup, a radiological examination was not necessary in this child.

Paradoxical vocal cord motion—A case report

Paradoxical vocal cord motion (PVCM) is an unusual cause of stridor, which is associated with some underlying causes, such as central nervous system lesion, gastroesophageal reflux or psychogenic problem. Once a diagnosis of PVCM is made, acute management with reassurance and sedation instead of aggressive airway intervention is required. Speech therapy, psychotherapy combination with anti-reflux medication is considered to be useful in long-term management. We present a 58 year-old male patient who had suffered from several episodes of acute onset of stridor, short of breath and tachypnea since one year ago. He was initially treated as an asthmatic patient with poor response. Aneurysm of ascending aorta by angiography, and mild gastroesophageal reflux with hiatal hernia by panendoscopy were noted. Then, the paradoxical vocal cord motion during inspiration phase was confirmed by flexible fiberoptic nasopharyngoscope after the consultation with an otolaryngologist. The emergency of his air-hunger was relieved quickly after psychological intervention. Now, he is free of stridor attack under anti-reflux therapy and psychotherapy.

Laryngeal Stridor in Multiple System Atrophy

The purpose of this study was to elucidate the clinical features of laryngeal stridor in 104 patients with multiple system atrophy (MSA) and to predict the hazard risk. Stridor was observed in 36 patients. It occurred in the first year of the disease in 10 cases, and 69% of the cases were diagnosed with stridor within the first 4 years. Dysphagia and hoarseness had a statistically higher frequency in the stridor group, and the onset period of these elements correlated with the onset of stridor. A follow-up study of survival probability was carried out in 83 patients. The median survival period in the stridor group (33 cases) and the non-stridor group (50 cases) was 8.0 and 9.0 years, respectively. Treatment for stridor decreased the relative risk from 2.998 to 0.147. Laryngeal stridor is a common and early clinical symptom in MSA. Early treatment for stridor is advisable to reduce mortality.

Herpes Laryngitis and Tracheitis Causing Respiratory Distress in a Neonate

A newborn presented 1 week after birth with the sudden onset of stridor and respiratory distress. At endoscopy, the supraglottic and subglottic tissues were edematous and erythematous, and numerous plaquelike ulcers were seen on the mucosal surface. Cultures of the lesions yielded herpes simplex virus type 2. The infant required a prolonged course of acyclovir and remained intubated for 31 days, but ultimately had both virological and clinical cure. Evaluation and further treatment of this unusual presentation of herpes simplex virus are discussed, as are the implications of herpes infections in neonates.

Subglottic stenosis in newborn intensive care unit graduates.

Five infants with postintubation subglottic stenosis were identified among 64 intubated patients in a follow-up clinic. The presence of laryngeal lesions was not suspected until three weeks to three months after discharge from their initial hospitalization. The onset of stridor, often precipitated by respiratory illness, led to the diagnosis, which in one case was delayed for as long as three months. No correlation was found between the presence of the severity of laryngeal pathology and the gestational age of the infants or the duration of intubation in this study. In spite of the precautions taken for the intubation of neonates requiring assisted ventilation, subglottic stenosis may develop in these infants and should always be considered in newborn intensive care unit graduates when they manifest refractory or recurrent respiratory obstruction in the first year of life. Routine follow-up of all intubated neonates to detect subglottic stenosis is recommended.

Bronchogenic Cysts: A Case Report

The otolaryngologist has a reference frame for congenital stridor that rarely includes diagnosis of a bronchogenic cyst. The life-threatening potential of this lesion makes consideration and recognition imperative. Representing less than 5% of the mediastinal childhood masses in the infant, respiratory distress most often initiates diagnostic studies leading to identification and extirpation. The case presentation highlights the clinical course. The diagnostic hallmark of this case was the delayed onset of stridor with subsequent progression. Thereafter, a chest film and barium swallow suggested the diagnosis. In newborns, however, such cysts may not be evident on routine chest films and, nonetheless, cause significant respiratory distress from airway compression. Surgical extirpation should be affected as soon as possible after the diagnosis is entertained in order to insure against a sudden respiratory death.