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Karina T. Cañadas, MD Pediatric Otolaryngology, Head & Neck Surgery Texas Children's Hospital Assistant Professor Baylor College of Medicine

When Is Noisy Breathing in a Child Worrisome?

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Outline

•  Not all “noises” are the same

•  Anatomy

•  Defining & understanding different sounds

•  Applying what we have learned

Anatomy

http://img.medscapestatic.com/pi/meds/ckb/80/44980tn.jpg

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Stertor •  Coarse heavy snoring sound

•  Causes: transmitted sounds caused by upper airway congestion or excessive mucous

•  DDx: URI, allergic rhinitis, sinusitis

•  Dx: H&P

•  Degree of urgency: routine

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Inspiratory Stridor •  High pitched whistling

sound on inspiration only

•  Causes: collapse of upper airway structures on glottis during inspiration

•  DDx: laryngomalacia, GERD

•  Dx: fiberoptic laryngoscopy

•  Degree of urgency: routine to urgent

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Inspiratory Stridor •  High pitched whistling

sound on inspiration only

•  Causes: collapse of upper airway structures on glottis during inspiration

•  DDx: laryngomalacia, GERD

•  Dx: fiberoptic laryngoscopy

•  Degree of urgency: routine to urgent

http://www.primehealthchannel.com/wp-content/uploads/2013/02/Laryngomalacia-Image.jpg

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Biphasic Stridor •  Fine whistling sound on both inspiration

and expiration. Usually accompanied with increased work of breathing

•  Causes: obstruction below the vocal cords

•  DDx: subglottic stenosis, complete tracheal rings, severe tracheomalacia, aortic anomalies causing tracheal compression, croup, subglottic cyst

•  Dx: requires DLB

•  Degree of urgency: urgent/emergent

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Wheezing •  Very high pitched sound usually

occurring, or most prominent, at the end of expiration

•  Causes: Obstruction of lower airway •  Diagnosis: Auscultation of the chest,

CXR

Wheezing •  *Not all that wheezes is asthma*

•  ** a two-tone high-then low pitch sound on auscultation unilaterally indicates a foreign body aspiration until proven otherwise **

•  Degree of urgency: EMERGENT

•  Dx & Tx: DLB

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When is Noisy Breathing Worrisome?

•  Associated with history of intubation, FTT, blue spells, labored breathing

•  Refer whenever you are worried or feel

uncomfortable taking care of the patient

References

•  http://kidshealth.org/EN/images/illustrations/xraySoftTissue-400x565-rd1-enIL.gif •  https://www.youtube.com/watch?v=dl8cxkQCDtk •  https://www.youtube.com/watch?v=oeoAze-CHng •  http://www.primehealthchannel.com/wp-content/uploads/2013/02/Laryngomalacia-Image.jpg •  https://www.youtube.com/watch?v=nwYHryiy3HY •  https://www.youtube.com/watch?v=GXKDvE6v-6s •  https://courses.washington.edu/conj/resp/airways.jpg