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³Harsh, usually high pitched, turbulent sound due to partial obstruction in the larynx/ tracheo-bronchial tree and is usually associated with dyspnoea´.
Other types of noisy breathing
Stertor: Harsh, low-pitched turbulent sound during respiration due to partial obstruction proximal to the larynx and may be associated with dyspnoea Snoring: Same+ only during sleep Apnea: Cessation of breathing Sleep apnea syndrome: >30 apnea episodes during 8 hours of sleep
Stridor: Things to know Types Pitch Site of obstruction Severity Causes .
Types Inspiratory (croup) Glottic Supraglottic Hypopharynx Expiratory (wheeze) Distal trachea Bronchi Biphasic Subglottic Proximal trachea .
Severity Mild Only on unaccustomed exertion Deep breathing Moderate On minimal exertion Not able to do day-to-day activities Severe Even at rest Accessory muscles are active Recession Features of hypoxemia like tachycardia. tachypnoea. irritability and restlessness . cyanosis.
Pitch Low pitch Proximal High Distal .
Site of obstruction Type Pitch Associated symptoms Examples: Hoarseness: Larynx Dysphagia/ FB sensation in throat: Hypopharynx Hot-potato voice: Supraglottic/ oropharynx .
Etiology in children tridor in children ongenit l cq ired ryngo l ci y t or teno i yre i l n ecti e c yre i l e r or e rologic l etc .
tumors Glottic: Webs. palsy. lymphangioma. tumors . etc. cyst Subglottic: Stenosis. lingual thyroid. haemangioma. Mandible: Micrognathia Laryngeal Supraglottic: LARYNGOMALACIA. cysts.Congenital Proximal to larynx Nose: Choanal atresia Tongue: Macroglossia.
Tracheobronchial Vascular loops T. stenosis .E.Fistula Mediastinal congenital tumors Atresia.
acute tonsillitis. retro/ parapharyngeal abscess. . etc. ludwig¶s angina.A uired INFECTIVE Acute epiglottitis Acute laryngo-tracheo-bronchitis Laryngeal diphtheria Laryngeal odema secondary to uinsy.
TRAUMATIC FB in upper aero-digestive tract Thermal Chemical Physical.RTA Radiation .
TUMORS Juvenile laryngeal papillomatosis Chondroma Thymoma Cystic hygroma .
VC palsy Allergy: Angioneurotic odema Laryngismus stridulus Tetany Tetanus .OTHERS Neurological: Bil.
any neck/ mediastinal mass Ca. trachea.ETIOLOGY IN ADULTS Trauma: Laryngotracheal trauma. Larynx Ca. thyroid. pharynx. esophagus. laryngotracheal stenosis-RTA/ iatrogenic. bronchus. FB Tumor: Larynx. neck space infections Allergy: Angioneurotic odema Neurological: Bilateral abductor palsy Post thyroidectomy/ CTS . Hypopharynx Infection: TB laryngitis.
Evaluation Objectives Site Severity Cause Best way to secure the airway Methods History Clinical examination Investigations First aid management as you evaluate Hospitalize/ early referral .
Malignancy Long-Benign.inflammatory/ traumatic Moderate. How? Duration: Short.History Onset: Congenital/ later. VC palsy Progression Fever +/Voice Feeding FB/ trauma/ corrosive poisoning Cyanotic speels Choking spells at night Relation to posture Aspiration Other throat/ neck/ chest symptoms .
neck and RS examination ILS.Clinical examination Type Severity Systemic features of infection Postural relation Se uential auscultation Complete ENT.done with caution/ contraindicated in moderate-severe stridor Voice/ cry .
Caution: Can give rise to laryngospasm Rigid/ flexible Bronchoscope.neck/ mediastinum Angiography Endoscopy Rigid/ flexible Laryngoscope.after securing airway .Investigations Radiography Plain X-ray neck AP/ lateral Chest X-ray.PA/ lateral Barium swallow CT scan.
Treatment Conservative Intubation Cricothyroidotomy Tracheostomy .
parenteral and high dose Humidification Mucolytics O2 administration IV fluids Feeding Positioning SOS bronchodilators NO SEDATION .parenteral Steroids.Conservative Antibiotics.
Intubation ADVANTAGES Easy and uick in some cases DISADVANTAGES Difficult intubation Prolonged intubation.stenosis Morbid RT feeds Difficult to maintain Tracheo-bronchial toilet.difficult Airway resistance and deadspaceincreased .
Tracheostomy ADVANTAGES By pass Prolonged periods Maintainance easy Morbidity: less Airway resistance reduced Dead space reduced Tracheobronchial toilet better Swallow DISADVANTAGES More time to secure airway Surgical procedure Major in children Difficult in children Expertise Complications .
Crico-thyroidotomy Cricothyroid membrane in the midline Large bore needle Stab incisioncatheter .
Other methods Trans tracheal O2 administration Mini-tracheostomy Per-cutaneous tracheostomy .
Multidisciplinary approach Treatment of the cause .