OTORHINOLARYNGOLOGY

SEMINAR 9
STRIDOR
 LEARNING OUTCOMES
• CAUSES
• ETIOPATHOGENESIS
• CLINICAL FEATURES
• INVESTIGATIONS
• TREATMENT
 WHAT IS STRIDOR?
• is a noisy breathing produced by turbulent air
flow through the narrowed air passages.
• 3 types of stridor :-
a) Inspiratory stridor
b) Expiratory stridor
c) Biphasic stridor
 COMMON CAUSES
• ACUTE EPIGLOTTITIS*
• ACUTE LARYNGEOTRACHEOBRONCHITIS*
• RETROPHARYNGEAL ABSCESS
• FOREIGN BODY ASPIRATION
ACUTE EPIGLOTTITIS
 ACUTE EPIGLOTTITIS
• It is an acute inflammation in the supraglottic region
of the oropharynx with the inflammation of the
epiglottis, vallecula, arytenoid and aryepiglottic.
• Rapidly progessive
• Common in children 2-7 y/o
• Emergency case from start of the symptom to the
total respiratory obstruction(may be short).
 CAUSES
1. H. influenza type B (most common) in
children
2. Streptococcus pneumoniae
3. Group A streptococci
4. Trauma
 SYMPTOMS
1. Stridor
2. Dyspnea
3. Fever
4. Dysphagia
5. Severe sore throat
6. Drooling
7. Muffled voice
8. Tripod position
 SIGNS
• Epiglottitis is swollen and red.
• Indirect laryngoscopy – oedema and
congestion.
 INVESTIGATION
• Lateral soft tissue X-ray of neck (thumb sign).
 TREATMENT
1. Hospitalization
2. Antibiotics – Ampicillin or 3rd gen
cephalosporin given IV or IM
3. Steroids – Hydrocortisone or Dexamethasone
IV or IM
4. Hydration
5. O2
6. Intubation or tracheostomy
ACUTE LARYNGO-TRACHEO-BRONCHITIS
(CROUP)
 OVERVIEW
• Inflammatory condition of the larynx, trachea
and bronchi.
• Viral infection (parainfluenza type 1 & 2)
affecting children between 6 months and 3
years of age.
• More common than acute epiglottitis.
• Spread through direct inhalation from cough
or sneeze or contamination of hands.
 PATHOPHYSIOLOGY
Inhalation of virus through nose or
nasopharynx

Respiratory epithelium becomes

inflamed and oedematous

Airway narrowing

Airflow through the airway becomes

turbulent(stridor)
 CLINICAL FEATURES
1. Starts with URTI with hoarseness and croupy
cough.
2. Difficulty in breathing and inspiratory stridor.
3. Signs of upper airway obstruction :-
suprasternal and intercostal recession.
 INVESTIGATION
1. FBC
2. ABG – hypoxia and hypercapnia in respiratory
failure
3. X-ray – Steeple sign
4. Laryngoscopy
 TREATMENT
1. Hospitalization – due to difficulty in breathing
2. Antibiotics – Ampicillin 50mg/kg/day are effective
against 2nd infections due to Gram-positive cocci and
H.influenzae.
3. Humidification – soften crusts and tenacious secretions
4. Hydration IV
5. Steroids – to relieve oedema
6. Adrenaline –(bronchodilator) to relieve dyspnoea
7. Intubation or tracheostomy