Neonatal Stridor Research Articles

Bilateral Vocal Fold Abduction Dysfunction: A Report of Two Neonatal Cases.

Stridor is caused by oscillation of the narrowed upper airway. The most common cause of neonatal stridor is laryngomalacia, followed by vocal fold abduction dysfunction. Herein, we present two neonatal cases of idiopathic dysfunction of vocal fold abduction. A neonate was admitted to the neonatal intensive care unit (NICU) on day 4 of life for inspiratory stridor, intermittent subcostal retraction, and cyanosis. A second neonate was admitted to the NICU on day 7 of life for inspiratory stridor and cyanosis when crying. Neither patient had dysmorphic features or unusual cardiac ultrasonography findings. The diagnosis was confirmed by laryngo-bronchoscopy. Conservative treatment with biphasic positive airway pressure was effective in both cases and symptoms resolved within a few months. Resolution of vocal fold abduction dysfunction was confirmed by repeat endoscopy. Clinical manifestations of vocal fold abduction dysfunction vary widely. Although most cases resolve spontaneously, prolonged tube feeding, or even tracheostomy, is needed in some severe cases. Diagnosis of vocal fold abduction dysfunction requires a laryngo-bronchoscopy study; thus, there may be a large number of undiagnosed patients. Vocal fold abduction dysfunction should be considered in the differential diagnosis for neonatal inspiratory stridor.

MANAGEMENT OF CONGENITAL BILATERAL ABDUCTOR VOCAL CORD PALSY FOR TRACHEOSTOMY IN A NEONATE

Bilateral abductor vocal cord palsy is very rare, and is still the second most common cause of congenital stridor in neonates. It can also cause breathing difficulty and cyanosis in neonates during increased crying spells, and hence eventually might require invasive airway management. This is a case report of a 7-day old neonate posted for tracheostomy under general anaesthesia.

Investigation and management of stridor in neonates

Stridor is an uncommon yet potentially serious symptom in neonates. It is indicative of airway obstruction. This short article describes how to approach a baby with stridor. Assessment and investigation should proceed in a structured manner. Important clues about the likely cause can be determined using a combination of a careful history and clinical examination. The character and nature of any stridor, combined with information about the onset of symptoms are particularly important. These may help to determine the best initial investigations, including direct visualization of the airway and management. There are different types of airway endoscopy, ranging from awake flexible laryngoscopy that examines to the level of the vocal cords, to rigid laryngotracheobronchoscopy under general anaesthesia that allows additional examination of the subglottis, trachea and main bronchi, and to flexible bronchoscopy that assesses the respiratory tract further still and is particularly useful in assessment of tracheomalacia. A cross-speciality approach is often required to secure the best outcomes. This article is aimed at the whole team who will be involved in dealing with babies with stridor, including anaesthetists, paediatricians, advanced care practitioners and ENT doctors.

Neonatal stridor presents at home – vocal fold paralysis as rare presenting feature of CHARGE syndrome

Abstract Objectives To present an unusual presentation and diagnosis of CHARGE syndrome with vocal fold paralysis, a rarely associated congenital laryngeal anomaly, as the presenting feature. Case presentation A four-day old, full-term, male infant born via uncomplicated vaginal delivery with a nursery course significant for failed hearing screen presented to an emergency department (ED) with respiratory distress and worsening stridor. He was transferred to a level III neonatal intensive care unit (NICU) for further evaluation and required intubation due to progressive hypercarbia. Laryngoscopy revealed left-sided unilateral vocal fold paralysis (VFP). He underwent further evaluation that included a normal MRI brain, neck and chest. Genetics was consulted with concern for dysmorphic features on physical exam. Following gene panel testing, VFP was attributed to known association with CHARGE syndrome. Airway edema was noted on laryngoscopy that prevented extubation until two months of age. Further features of CHARGE syndrome identified included colobomas, glaucoma, sensorineural hearing loss, and genital abnormalities. He was discharged in room air and following gastrostomy tube placement with otolaryngology follow up. Conclusions Although choanal abnormalities are classically associated with CHARGE syndrome, other upper airway anomalies such as VFP may be present. VFP is a rarely reported anomaly in association with CHARGE syndrome (Naito Y, Higuchi M, Koinuma G, Aramaki M, Takahashi T, Kosaki K. Upper airway obstruction in neonates and infants with CHARGE syndrome. Am J Med Genet 2007;143A:1815–20; Morgan D, Bailey M, Phelps P, Bellman S, Grace A, Wyse R. Ear-nose-throat abnormalities in the CHARGE association. Arch Otolaryngol Head Neck Surg 1993;119:49–54).

Anaesthesia and laryngomalacia - A case report

Laryngomalacia is one of the commonest causes of congenital stridor in neonates. The treatment depends on the severity of the stridor. We present a case of 12 day old neonate with a history of stridor who was diagnosed to have laryngomalacia on clinical examination and confirmed by flexible fibreoptic bronchoscopy. The neonate underwent excision of excessive aryepiglottic fold under general endotracheal anaesthesia with controlled ventilation as the definitive surgery.

Suture lateralization in congenital bilateral vocal cord immobility in neonates and infants: A hybrid approach

IntroductionBilateral vocal cord immobility (BVCI) is a leading cause of stridor and airway obstruction in neonates which may arise idiopathically, as a result of birth trauma, or in the setting of Central nervous system lesions such as Arnold-Chiari malformation. Although many children with BVCI may be managed conservatively, surgical intervention may be necessary in those patients with ongoing upper airway obstruction. Many interventions have been described including, tracheostomy, cordotomy, cricoid splitting procedures, and arytenoidectomy. Vocal cord suture lateralization has the advantage of being both reversible and less morbid than other surgical interventions for BVCI. This study describes a novel variation of the suture lateralization procedure which aids in correct placement of the suture thus minimizing multiple needle passes and associated laryngeal edema. MethodsA retrospective chart review was undertaken of five patients undergoing suture lateralization of the vocal cord for BVCI at a single institution over a 10 year period. Post-operative voice and swallow outcomes were recorded. ResultsOf five patients undergoing this procedure four returned to normal diet. One was diagnosed with a progressive neurological disorder and was persistently fed via gastrostomy tube. Three of the five patients spontaneously recovered vocal cord function and went on to have normal voice after suture removal. ConclusionSuture lateralization is a safe and effective means of alleviating upper airway obstruction in BVCI. It has the advantages of being reversable and minimally invasive; however, optimal suture placement is both vital and challenging. The novel technique described in this study allows identification of landmarks as and aid to suture placement thus reducing the need for multiple needle passes into the lumen of the larynx.

Stridor After Tracheoesophageal Fistula Repair: Where Is the Lesion?

Stridor After Tracheoesophageal Fistula Repair: Where Is the Lesion?

Vallecula-cyste: een zeldzame oorzaak van progressief toenemende inspiratoire stridor bij een neonaat

Vallecular cyst: a rare cause of progressive inspiratory stridor in a neonate The medical history of an infant with progressive inspiratory stridor caused by a vallecular cyst is presented. The cyst was diagnosed via a laryngoscopy and treated by means of an excision. The postoperative course was complicated by severe stridor induced by post-intubation edema. This report elaborates on the clinical presentation and work-up. The differential diagnosis of neonatal stridor is exhaustive. A congenital vallecular mass rarely causes it. These masses can manifest in various ways. Symptoms usually develop during the first week(s) of life. Key symptoms are upper airway obstruction and feeding difficulties. Life threatening situations are also possible. Given that the exact etiology of vallecular cysts remains unclear, different hypotheses were proposed. The differential diagnosis should include a dermoid cyst, a thyroglossal duct cyst, a teratoma, an hemangioma or lingual thyroid. The diagnosis usually requires a flexible and/or direct laryngoscopy. Radiographic imaging may also contribute to the work-up, adding information about the anatomical dimensions (for example with regard to the surrounding structures), the exact location, the magnitude, the content, etc. The definitive diagnosis is made through pathological evaluation. Different treatment options are proposed, preferably endoscopic excision or marsupialization.

Laryngoscopy in Neonates and Infants presenting with stridor in tertiary care hospital

INTRODUCTIONNeonatal life involves the readaptation of gas exchange from the intrauterine to extrauterine environment. Stridor in this period reflects a critical airway obstruction which may have been anticipated or wholly unexpected. Many congenital and acquired diseases may cause airway obstruction and respiratory distress in infants.AIMS AND OBJECTIVESTo study the causes of stridor in neonates and infants.Early diagnosis and treatment of the stridor to prevent morbidity and mortality.METHODSThe study was observational study. In this study both qualitative and quantitative approaches were used to collect, analyse and interpret the data. Patients with stridor under age of 1 year who were referred to our department were taken in this study BY DIRECT LARYNGOSCOPYDirect laryngoscopy with macintosh laryngoscope or miller’s blade was done.Results: In our study the most common symptom at presentation was stridor which was present in all 25 cases we have taken.13 cases were presented with difficulty in feeding along with the stridor. This was 2nd most common symptom of presentation.Stridor was associated with fever and cough cold in 13 cases. Change of cry along with stridor observed in 6 cases Result and CONCLUSIONFNPL is gold standard for diagnosis and very useful and safe procedure. Use of better technology and continuous monitoring in NICU/PICU in tertiary care hospital and observation by team of doctors (Pediatrician, ENT Specialist, intensivist etc.) have definitely reduced the rate of morbidity and mortality.

Lesão congênita rara como causa atípica de estridor neonatal: relato de caso de teratoma congênito de orofaringe (epignathus) causando manifestação tardia de obstrução de via aérea

BACKGROUND: Epignathus is the term used for congenital oropharyngeal teratoma, a rare condition however with great potential to cause fetal airway obstruction, attending with respiratory insufficiency and being able to cause perinatal death. Usual imaging exam in pregnancy follow-up such as ultrasonography can detect mass-type lesions occupying the head and neck region of the fetus, also commonly associated with polydramnium. The early diagnosis of Epignathus assists in planning management as delivery and adequate procedures to guarantee the fetal airway. CASE: We report an atypical case of a 44-day-old baby girl, born without complications, but with parents reports of mild stridor from birth without investigation, progressed with severe respiratory insufficiency requiring orotracheal intubation in emergency service. At the time, a mass was detected on oropharynx obstructing airway. After the surgical exeresis of the mass, histopathological study revealed mature teratoma. CONCLUSION: Neonatal stridor, however mild, requires an adequate investigation of the probable etiology. In medical practice, cases of severe stridor associated with symptoms such as respiratory effort or difficulty feeding tend to be more valued. Epignathus is not a common cause of neonatal stridor, especially in cases of late manifestations.

Efficacy and toxicities of low-temperature plasma radiofrequency ablation for the treatment of laryngomalacia in neonates and infants: a prospective randomized controlled trial.

BackgroundLaryngomalacia is the most common cause of stridor in neonates and infants, and supraglottoplasty is the mainstay of surgical treatment. Although low-temperature plasma radiofrequency ablation (LTP-RFA) using coblation technology has been used for treating laryngomalacia, it is still lack of high-quality clinical evidence. Therefore, we conduct this prospective randomized study to clearly define the role of LTP-RFA for the treatment of laryngomalacia in neonates and infants.MethodsBetween Jan 2017 and Dec 2019, a total of 89 children with laryngomalacia were included for analysis. All patients were initially stratified according to the severity of laryngomalacia. Patients with severe laryngomalacia were randomly assigned to receive LTP-RFA or traditionally surgical supraglottoplasty, while patients with moderate laryngomalacia were assigned to LTP-RFA or observation. The primary end point was the efficacy and toxicities of LTP-RFA by assessing the changes of clinical score and visual analogue scale (VAS) symptom score. The total score was the combination of clinical score with VAS score.ResultsOf the 89 children, 40 children presented with severe laryngomalacia, and the remaining 49 children were diagnosed as moderate laryngomalacia. The median age was 68 days (range, 19 to 337 days). For children with severe laryngomalacia, our results showed that LTP-RFA treatment significantly reduced the operative time (5.55±1.66 vs. 18.7±5.31 min, P<0.001), length of hospital stay (6.71±1.15 vs. 7.95±1.55 days, P=0.008) and the amount of intraoperative hemorrhage (1.71±1.79 vs. 4.90±1.82, P<0.001) when compared to traditionally surgical supraglottoplasty, while the treatment efficacy was comparable between LTP-RFA and traditionally surgical supraglottoplasty in terms of changed total score (P=0.322), changed clinical score (P=0.135) and changed VAS symptom score (P=0.559). Additionally, for children with moderate laryngomalacia, LTP-RFA treatment significantly improved the symptom evaluated by total score (P<0.001), clinical score (P<0.001) and VAS symptom score (P<0.001) in comparison with the observation group. Post-operative pneumonia was observed in 10 patients. No surgical related death was reported.ConclusionsThe present study indicated that LTP-RFA was an effective treatment option for both severe and moderate laryngomalacia in neonates and infants with a low intraoperative complication. Long-term outcomes of LTP-RFA for laryngomalacia would be reported in further studies.

Utility of polysomnography and video swallow studies in the management of pediatric patients with congenital idiopathic bilateral vocal fold dysfunction

ObjectivesCongenital idiopathic bilateral vocal fold dysfunction (BVFD) is an uncommon cause of neonatal stridor and respiratory distress postnatally. Approximately 50% of affected neonates or infants will historically require tracheostomy for this condition. Timing and candidacy for tracheostomy in BVFD patients is often subjective and poorly understood. Polysomnography (PSG) and video swallow studies (VSS) may be helpful in the management of patients with BVFD prior to tracheostomy by quantifying their degree of upper airway obstruction during sleep and feeding dysfunction while awake. MethodsWe performed a single-institution retrospective case series of BVFD patients from 2000 to 2018 who had postnatal PSGs performed prior to tracheostomy. Demographics, gestational age, and VSS results prior to PSG were recorded for all patients. Findings from PSGs included non-REM AHI, REM AHI, oxygen nadir, % total sleep time (TST) O2<90%, peak end-tidal (ET) CO2, % TST ETCO2 >52 torr. Rates of post-PSG tracheostomy, gastrostomy tube (G-tube) placement, and home O2 supplementation were noted for all patients. ResultsFrom 2000 to 2018, 12/46 (26%) BVFD patients had postnatal PSGs performed prior to tracheostomy. Median patient age at BVFD diagnosis, VSS, and PSG was 5.5 days, 12.5 days, and 17.5 days, respectively. Mild, moderate, and severe obstructive sleep apnea (OSA) was found in 7/12, 3/12, and 4/12 patients, respectively. Hypercapnia (ETCO2 >52 torr) was found in 5/12 patients on PSG while hypoxemia (SpO2 <90% for >4% TST) was not found in any patient. VSS results demonstrated normal swallowing, inconsistent laryngeal penetration, and silent aspiration in 7/12, 2/12, and 3/12 patients, respectively. Tracheostomy and G-tube placement was performed in 3/12 and 2/12 patients, respectively. There was no association between the severity of OSA or any PSG abnormality, VSS findings, and the performance of tracheostomy in any BVFD patient. ConclusionsOSA was found in all BVFD patients undergoing postnatal PSG at our institution while feeding dysfunction was found in approximately 50% of patients. The presence of feeding dysfunction, severe OSA, or any PSG abnormality was not individually associated with the subsequent performance of a tracheostomy in our patients. PSG is likely useful in supporting but not supplanting one's clinical decision-making in the management of patients with congenital idiopathic BVFD.

Congenital vallecular cyst causing severe inspiratory stridor in a newborn

Vallecular cyst is a rare but observed cause of neonatal stridor that can present with respiratory distress and feeding difficulties arising from upper airway obstruction. Stridor in neonates is usually congenital in nature and most often caused by laryngomalacia. We present a case of vallecular cyst in a term newborn infant with persistent inspiratory stridor that was diagnosed by direct laryngoscopy and underwent successful treatment by marsupialization with complete resolution of the stridor. This case highlights the importance of a thorough interdisciplinary evaluation of persistent neonatal stridor paving the way to early diagnosis and intervention to avoid critical airway obstruction and potentially fatal outcomes. • Vallecular cyst is an uncommon cause of neonatal stridor. • Early evaluation of stridor facilitates intervention to avoid critical airway obstruction. • Diagnosis of vallecular cyst is made by direct laryngoscopy. • Marsupialization via coblation remains as the treatment of choice for vallecular cyst.

Study on Etiopathogenesis of Stridor in Neonates, Infants and Children in Tertiary Care Hospital

Study on Etiopathogenesis of Stridor in Neonates, Infants and Children in Tertiary Care Hospital

An unusual cause of infant\u2019s stridor \u2013 congenital laryngocele

Congenital laryngocele is an uncommon cause of neonatal stridor. There are only a few cases reported in the literature. The authors present a successfully treated case of an infant, whose life could only be saved by urgent tracheostomy. On the 5th postoperative day endoscopic excision and marsupialization provided patent airway. The patient could be decannulated. During follow-up no recurrence was observed.

Bronchogenic cyst of the neck occurring as a submandibular swelling in an adult: A case report based on a rare presentation

Bronchogenic cysts are rare and benign congenital malformations. They arise from ventral surface of foregut during development and commonly present in mediastinum and intrapulmonary region. Bronchogenic cysts are often incidental findings in childhood. Majority of them are symptomless and rarely associated with symptoms such as stridor in neonates, dysphagia, dyspnea on exertion, and recurrent infection. Here we present a case of a bronchogenic cyst presented as Submandibular swelling in an adult a rare presentation.

A rare case of congenital laryngeal cyst and its surgical management

&lt;p class="abstract"&gt;Congenital laryngeal cyst is a rare occurrence. It is an important but rare cause of neonatal stridor and should be kept as a provisional diagnosis after ruling out laryngomalacia. The case study tells us the importance of doing a laryngoscopic examination in every neonate presenting with stridor. The patient in our study underwent endoscopic marsupialization of the cyst which happens to be the treatment of choice in case of a laryngeal cyst.&lt;/p&gt;&lt;p class="abstract"&gt; &lt;/p&gt;

Paediatric Bilateral Vocal Cord Paralysis: Our Experience

Bilateral vocal cord paralysis (BVCP) is the second most common cause of neonatal stridor. The aim of this study was to describe the demographic features, aetiology, comorbidities, and management of our patients with BVCP. Material and methodsWe conducted a retrospective review of the clinical charts of all patients diagnosed with BVCP seen at the Department of Respiratory Endoscopy between 2011 and 2015. Results47 patients were included. Mean age at diagnosis was 1 month and male sex predominated (63%). The aetiology was congenital in 59% and acquired in 41% of the infants. The cause was most frequently idiopathic in the former group and secondary to postoperative injury in the latter. Overall, 42 patients (89%) required tracheostomy, without statistically significant differences between the causes. Of all the patients, 39% regained vocal-cord mobility; 44% of those with congenital BVCP, 31% of those with acquired BVCP and 62.5% with idiopathic BVCP. In five patients a laryngotracheoplasty was performed with a posterior costal cartilage graft and one underwent posterior cordectomy. All were decannulated. In one patient vocal-cord lateralisation was performed, avoiding tracheostomy. ConclusionBVCP was most commonly of congenital cause and was mainly idiopathic within this group of patients, with a slight male preponderance. A high percentage of patients required tracheostomy. A higher recovery rate of vocal-cord mobility was observed in idiopathic BVCP, which allowed for successful decannulation. In this series, decannulation was possible in all patients that underwent surgery; however, further studies with comparison of techniques and objective assessment of swallowing and phonation are necessary.

Challenges in removal of congenital nasopharyngeal teratoma in a 5 day old neonate

&lt;p class="abstract"&gt;Neonatal stridor is a serious condition which poses a challenge in diagnosis and requires immediate evaluation of the underlying etiology. Tumors of the head and neck region are among the more unusual causes of airway obstruction in the neonatal period. Amongst them, nasopharyngeal teratomas are rare entities accounting for less than 10% of all tumours. We present the rare case of a nasopharyngeal teratoma causing inspiratory stridor and critical airway obstruction in a newborn at birth. This tumour was removed successfully using novel coblation technique in a 5 day old neonate managed without even a tracheostomy. We present the challenges faced in diagnosis and surgical management of teratoma at a site with difficult access like nasopharynx in a 5 day old newborn which could be safely and successfully removed using coblation technology.&lt;/p&gt;&lt;p class="abstract"&gt; &lt;/p&gt;&lt;p&gt; &lt;/p&gt;

Parálisis bilateral de cuerdas vocales en pediatría: nuestra experiencia

Bilateral vocal cord paralysis (BVCP) is the second most common cause of neonatal stridor. The aim of this study was to describe the demographic features, aetiology, comorbidities, and management of our patients with BVCP. Material and methodsWe conducted a retrospective review of the clinical charts of all patients diagnosed with BVCP seen at the Department of Respiratory Endoscopy between 2011 and 2015. Results47 patients were included. Mean age at diagnosis was 1 month and male sex predominated (63%). The aetiology was congenital in 59% and acquired in 41% of the infants. The cause was most frequently idiopathic in the former group and secondary to postoperative injury in the latter. Overall, 42 patients (89%) required tracheostomy, without statistically significant differences between the causes. Of all the patients, 39% regained vocal-cord mobility; 44% of those with congenital BVCP, 31% of those with acquired BVCP and 62.5% with idiopathic BVCP. In five patients a laryngotracheoplasty was performed with a posterior costal cartilage graft and one underwent posterior cordectomy. All were decannulated. In one patient vocal-cord lateralization was performed, avoiding tracheostomy. ConclusionBVCP was most commonly of congenital cause and was mainly idiopathic within this group of patients, with a slight male preponderance. A high percentage of patients required tracheostomy. A higher recovery rate of vocal-cord mobility was observed in idiopathic BVCP, which allowed for successful decannulation. In this series, decannulation was possible in all patients that underwent surgery; however, further studies with comparison of techniques and objective assessment of swallowing and phonation are necessary.