27 Stridor and Stertor

8/16/2019 27 Stridor and Stertor

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ByDr. Baseem N. Abdulhadi

Stridor &Stertor



Stridor : it is a harsh, high-pitched, almostmusical sound, caused by vibration ofpartially obstructing soft tissue in the larynor upper trachea.

Stertor : it is rough noisy breathing, similar tosnoring, caused by vibration of partiallyobstructing soft tissues in the pharyn .

Wheeze : is a high-pitched hus!y or "histlingsound, caused by narro"ing of soft tissue inthe intrathoracic air"ays.

De#nitions:



$nspiratory Stridor$t occurs during inspiration only, often acro"ning sound, and is due to obstruction at theglottis, supraglottis or subglottis level.

% piratory Stridor$t occurs during e piration only, usually at aslightly lo"er pitch than inspiratory stridor, andis due to obstruction of the subglottis or

e trathoracic trachea.Biphasic Stridor$t involves both inspiration and e piration, and,"hile representing laryngeal obstruction, is a

hallmar! of severe obstruction.

Stridor



Bernoulli's principle



Stridor: history ta!ingAge of onset, duration, severity, and progressionprecipitating events 'e.g. crying, feeding(positioning 'eg, prone, supine, sitting( )uality andnature of crying presence of aphonia and otherassociated symptoms 'eg, paro ysms of cough,aspiration, di*culty feeding, drooling, sleepdisordered breathing(.

+erinatal history - maternal condylomata,endotracheal intubation use and duration, andpresence of congenital anomalies .

eeding and gro"th history, developmental

history.



eart and respiratory rates, cyanosis, use ofaccessory muscles of respiration, nasal aring, levelof consciousness, and responsiveness.

Note the presence of infection in the oral cavitycrepitations or masses in the soft tissues of the face,nec!, or chest and deviation of the trachea

/se care "hen e amining 'especially palpating( theoral cavity or pharyn because suddendislodgement of a foreign body or rupture of anabscess can cause further air"ay compromise.

Stridor : Examination



Drooling from the mouth - suggests poor handlingof secretions, Dysphagia.

0bserve the character of the cough, cry, andvoice.

1areful auscultation of the nose, oropharyn ,nec!, and chest helps to discern the location ofthe stridor.

Special attention to craniofacial morphology,

patency of the nares, and cutaneoushemangiomas.

Stridor : Examination



CAUSES: Acute Onset Stridor

1. Laryngotracheobronchitis (crou !the most common cause of acute stridor in children2 months to 3 yearsbar!ing cough that is "orst at nightlo"-grade fever

". As iration o# #oreign body4-3 yearsfood such as nuts, hot dogs, popcorn, and hard candyhistory of coughing and cho!ing that precedesdevelopment of respiratory symptoms

$. %acteria& tracheitisuncommonyounger than 5 yearssecondary infection 'most commonly due toStaphylococcus aureus ( follo"ing a viral process'commonly croup or in uen6a(



'. etro haryngea& abscesscomplication of bacterial pharyngitisyounger than 2 yearsabrupt onset of high fevers, di*culty s"allo"ing,refusal to feed, sore throat, hypere tension of thenec!, and respiratory distress

). *eritonsi&&ar abscessinfection in the potential space bet"een the superiorconstrictor muscles and the tonsilcommon in adolescents and preadolescents.patient develops severe throat pain and troubles"allo"ing or spea!ing




+. S asmodic crou (acute s asmodic &aryngitis!most commonly in children aged 4-5 yearspresentation may be identical to croup

,. A&&ergic reaction (ie- ana hy&axis!hoarseness and inspiratory stridor may be accompanied bysymptoms 'eg, dysphagia, nasal congestion, itching eyes,snee6ing, "hee6ing( that indicate the involvement of otherorgans

. E ig&ottitismedical emergencymost commonly in children aged 3-7 years1linically, the patient e periences an abrupt onset of high-grade fever, sore throat, dysphagia, and drooling




CAUSES: Chronic Stridor



4( 8aryngomalacia:It is the most common laryngeal anomaly

It is the most common cause of stridor in neonate and

chronic pediatric stridor

Clinical presentation:

Intermittent inspiratory stridor that improves in

prone position; worse with feeding, crying, or in

supine position; presents within weeks of birth; normal

voice; usually self-limiting as cartilage stiffens with growth

(around 2 years of age)



"! Subg&ottic stenosis

inspiratory or biphasic stridor

1ongenital: incomplete canali6ation of the

subglottis and cricoid rings.

Ac)uired: is most commonly caused by prolongedintubation.



3) Vocal cord dysfunction:

Unilateral vocal cord paralysis: congenital or secondary

to trauma at birth or time of cardiac or intrathoracic

surgery

Bilateral vocal cord paralysis: Pt present with aphonia

and a high-pitched stridor that may progress to severe

respiratory distress



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27 Stridor and Stertor

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