Paediatrics: Common presentation: stridor

Common presentation: stridor

Stridor is a noise heard during the inspiratory phase of breathing. It indicates either dynamic or fixed extrathoracic airway obstruction (anywhere from the nose to the thoracic inlet). When it arises acutely and is associated with respiratory distress, immediate attention is required. The differential diagnosis of stridor is as follows.

Nose and nasopharynx

·  Congenital obstruction, e.g. choanal atresia.

·  Inflammation, e.g. rhinitis and sinusitis.

Mouth, oropharynx, and hypopharynx

·  Congenital obstruction: e.g. macroglossia and glossoptosis.

·  Inflammation: e.g. tonsillar hypertrophy.

·  Masses: e.g. cystic hygroma or other malformation.

·  Foreign body.

Larynx

·  Congenital obstruction: e.g. laryngomalacia, laryngeal web or cleft, vocal cord paralysis.

·  Inflammation: e.g. gastro-oesophageal reflux.

·  Infection: e.g. epiglottitis, laryngotracheobronchitis.

·  Masses: e.g. haemangiomas, abscess.

·  Trauma: e.g. subglottic stenosis, foreign body inhalation.

Trachea

·  Congenital obstruction: e.g. tracheomalacia, tracheo-oesophageal fistula.

·  Infection: e.g. bacterial tracheitis.

There are specific treatments for many of these conditions. In persist-ent, non-medical causes of stridor, airway surgery may be required after endoscopy.