Abstract

Background: A child with stridor typically induces significant anxiety in the carer and should be a clinical priority for the medical professional. In the acute situation the paediatric airway can deteriorate rapidly and this can be a real challenge for the paediatrician, otorhinolaryngologist and anaesthesiologist. Stridor which is the main symptom of upper airway obstruction in infants, can be congenital or acquired, acute or chronic and the 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 study various etiological causes of stridor in neonates, infants and children are evaluated. It is important to evaluate the cause of stridor as the type and cause of the anatomical and functional abnormality determines the prognosis.

Materials and Methods: Cases (neonates,infants and children) presented with stridor to ENT OPD,to ENT casualty and referral cases from pediatrics department of King George Hospital,Visakhapatnam were evaluated and investigated during the period of one year from March 2017 to March 2018. The cause of stridor is evaluated by careful history taking, thorough physical examination  and imaging studies and endoscopy. Imaging studies include digital x-ray,plain CT , CECT , MRI. Endoscopic studies include direct examination of larynx and trachea by rigid as well as flexible endoscope.

Results: Out of 22 patients 14 patients presented with congenital causes and 8 patients presented with acquired causes of stridor. Most common cause(45%, 22 patients) of stridor in this study group is laryngomalacia. 3 cases had vocal cord palsy.2 cases presented with foreign body in trachea and one with foreign body in glottis.2 cases had post intubation injury,1 case with subglottic web,1 case with squamous papilloma,1 case with subglottic haemangioma,1 case was diagnosed as diphtheria. Immunisation history was normal in all patients except in one case which we encountered Diptheria.

Conclusion: Stridor is an important condition,in many cases implying an impending disaster with a very compromised airway. Evaluation should start from careful history taking and clinical examination. Persistent symptoms deserve referral to otorhinolaryngologists for flexible and rigid endoscopy.

Neonates with stridor should be managed in a multidisciplinary setting, by clinicians familiar with the intricate physiology of these children, and with access to the multitude of medical and surgical investigative and therapeutic options required to provide first-rate care.

Keywords: Neonate, Infant, Children, Stridor, Foreign Body, Laryngomalacia.