1. Defined: High-pitched noisy breathing caused by
turbulence from obstruction anywhere between nasal
or oral cavity to the bronchi (harsh, creaking sound)
Common in infants because of the small diameter of
their airways
Subtle abnormalities can cause obstruction in
newborns and infants

2. Inspiratory Stridor
Typically caused by obstruction at or above the level of
the vocal cords
Expiratory Stridor
Usually localized to the more distal tracheobronchial
tree
Biphasic Stridor
Usually caused by obstructions at the true vocal cords

3. Extrathoracic Airway Obstruction
Usually present with symptoms of obstruction
Hoarseness, brassy (“Barky”) cough, or stridor
Presence of agitation, air hunger, severe retractions,
cyanosis, lethargy require immediate intervention
Diagnostic evaluation should include chest and lateral
neck radiographs

4.  Congenital Laryngeal Anomalies
 Laryngomalacia-different types
 Tracheomalacia
 Vocal Cord Paralysis
 Laryngeal Clefts
 Vascular Rings and Slings
 Infectious
 “Croup” (Laryngotracheitis)
 Epiglottitis
 Tracheitis
 Trauma
 Croup Masquerade
 Subglottic Hemangioma
 Recurrent Respiratory
Papillomatosis
 Post Intubation Glottic and
Subglottic Lesions
 Congenital Glottic and
Subglottic Stenosis
 Extra-Esophageal
(Gastroesophageal) Reflux
Disease/Eosinophilic
Esophagitis
 Foreign Body
 Tracheal
 Esophageal
Laryngeal Stridor: Etiology

5. Presentation
Staccato inspiratory stridor
Worse with exertion, feeding, crying
Noisy breathing generally begins at about 2-4 weeks of age
 Endoscopic appearance
Omega epiglottis
Foreshortenend
aryepiglottic folds
Cuneiform prolapse

7. Acute Laryngotracheobronchitis

8. Inflammation of airway is present, but edema of the
subglottic space accounts for the predominant signs
of airway obstruction
Common, usually between ages 6 mos to 3 yrs
Boys>girls (3:2)
Seasonal – Fall and Winter

9. Causative Organisms
75% of cases are caused by Parainfluenza types 1, 2 & 3
RSV
Influenza A, B
Rubeola
Adenovirus
M. pneumoniae
Bacterial (pseudomembranous croup)
Severe and life-threatening

10. Classic presentation
Begins with URI symptoms (rhinorrhea, fever)
Hours to days later, sxs of upper airway obstruction
develop
Hallmark is hoarseness and a barking or “croupy” cough
(Seal bark) and inspiratory stridor
Mild-severe respiratory distress
Labored breathing, marked retractions

11. Diagnosis
Based primarily on history and exam
AP x-ray of the neck will show tapering subglottic
narrowing
“Steeple sign”
Not necessary to make diagnosis

13. Prognosis
Most have uneventful course and improve in a few days
Recurrence can occur in some instances
Suggests airway hyperreactivity

14. Supraglottitis

15. TRUE MEDICAL EMERGENCY!
Inflammation of the epiglottis and adjacent structures
Incidence has decreased dramatically with HIB
vaccine
Most cases occur in children 1-5 yrs.
Boys>Girls (only slightly)

16. Causative organism
Almost always H. influenza
Others include:
S. pneumoniae
H. parainfluenza
S. aureus

17. Presentation
Progression of illness more rapid than croup
Cough usually absent, high fever
Drooling, apprehension, dysphagia, respiratory distress,
and toxicity
Resist lying down
Classic “tripoding” posture
Sits upright with arms forward in front and neck extended to
maximize airway caliber
“Sniffing” position – head forward, jaw thrust forward, mouth
open

18. Diagnosis
Extreme care must be taken not to agitate the patient
or irritate the airway
Lateral x-ray of the neck
Thumb sign (rounded appearance of epiglottis)
Thickened aryepiglotic folds

20.  Weak, hoarse cry
 Mild-moderate respiratory
 distress

21. Thank you