The Obstructed Airway
Raymond W Clarke in Diseases of the Ear, Nose & Throat in Children, 2023
This will depend on the cause, but some features are constant (Box 22.1). A baby with an obstructed airway will be distressed, often demonstrating tachypnoea, recession of the soft thoracic cage on inspiration, and visible indrawing of the trachea (tracheal tug). The child struggles to feed. Stridor refers to a high-pitched noise, typically on inspiration, although expiratory stridor can present as well, especially if the obstruction is lower in the airway (e.g. in tracheomalacia). Stridor on inspiration and expiration (biphasic) is ominous and suggests severe airway compromise. The low-pitched ‘snoring’-type noise associated with pharyngeal airway obstruction is more often referred to as stertor, but the terms ‘stridor’ and ‘stertor’ are often used imprecisely. The noisy breathing associated with lower airway obstruction (e.g. in bronchial asthma) is usually referred to as ‘wheezing’.
The larynx
Rogan J Corbridge in Essential ENT, 2011
This is a condition most often seen in children and juveniles, but it can also appear in adulthood. The underlying cause is infection with the human papilloma virus (HPV). The route of transmission is probably inhalation; however, why some individuals are affected and others are not is not fully understood. It seems likely that a defect in some part of the immune system is responsible. The extent of the disease process is variable: it may affect only a small part of the larynx, or it may be widespread, involving the whole of the respiratory tree, including the trachea and rarely the bronchi. The child may undergo spontaneous regression at any stage, most commonly at puberty, although this is not uniformly the case. Regression in adulthood is rare. The most common site to be affected is the vocal cord and hence the symptoms consist of hoarseness. In the most severe cases, stridor may develop.
Burns, scalds and chemical and electrical injuries
Ffion Davies, Colin E. Bruce, Kate Taylor-Robinson in Emergency Care of Minor Trauma in Children, 2017
Exclude potentially major injuries before concentrating on the burn. Then follow the ABC procedure: Airway – are there burns, soot or swelling around the mouth and/or nose? Is there stridor?Breathing – is your patient wheezing or do they have stridor? What are their oxygen saturations?Circulation – burns do not cause circulatory compromise within a couple of hours, so if signs of shock are present, this should alert you to other injuries.
Prognostic factors and importance of recognition of adult croup
Published in Acta Oto-Laryngologica, 2018
Tomoyasu Tachibana, Yorihisa Orita, Takuma Makino, Yasutoshi Komatsubara, Yuko Matsuyama, Yuto Naoi, Michihiro Nakada, Yasuharu Sato, Kazunori Nishizaki
Child croup is often managed safely on an outpatient basis, and hospitalization and intubation are only required in 2% and 0.5–1.5%, respectively [8]. On the other hand, as AC patients often present in severe condition [3,6], some reports have indicated that AC should be managed by hospitalization or admission to the Intensive Care Unit (ICU) even for patients who do not need intubation [2,7]. Stridor has been reported as a prognostic factor for severe croup [1]. In the past 14 AC patients, stridor was observed in eight patients. Of these, six patients (75.0%) required airway intervention and three (37.5%) needed tracheostomy. In the present study, stridor was observed in only one case (5.6%), and no cases required airway intervention. Detailed observation of the subglottic region by laryngoscopic examination might help to detect severe cases which requires airway intervention.
Case report of a laryngeal tuberculosis during pregnancy – challenges in diagnosis and management
Published in Acta Oto-Laryngologica Case Reports, 2023
Julian Pfäffli, Amina Nemmour, Philipp Kohler, Sandro J. Stoeckli
Regarding its pathogenesis, laryngeal TB can be divided into primary laryngeal TB from direct invasion of bacilli into the larynx or secondary laryngeal TB due to direct bronchogenic spread from advanced pulmonary TB or via hematogenous or lymphatic spread from extrapulmonary sources. While older publications from the 1940s reported a vast majority of secondary laryngeal TB, a more recent review revealed a higher proportion of primary laryngeal TB. Due to its rarity and unspecific symptoms, laryngeal TB is easily misdiagnosed. Symptoms may mimic common disorders like laryngopharyngeal reflux (LPR) or malignancy. The most common symptoms of laryngeal TB are dysphonia (96%), weight loss (47%), cough (38%), dysphagia (26%) and odynophagia (25%). Stridor has been described in 9% of the cases with a potential need of tracheotomy for safe airway management [3].
Pediatric bronchoscopy: recent advances and clinical challenges
Published in Expert Review of Respiratory Medicine, 2021
P Goussard, P Pohunek, E Eber, F Midulla, G Di Mattia, M Merven, JT Janson
The most common indication for endoscopy is the presence of signs of airway obstruction. Persistent or severe inspiratory stridor should be evaluated, if associated with poor weight growth, episodes of apnea, cough while feeding, history suggestive for congenital malformations. In this case, the most common finding is laryngomalacia, even if the main purpose of bronchoscopy is to exclude other or concomitant malformations, like vocal cord paralysis, laryngeal web, subglottic stenosis, hemangioma, laryngeal cyst, or vocal cord dysfunction [25,27]. Bronchoscopy is mandatory even in case of stridor, to rule out if tracheomalacia, congenital (e.g. complete tracheal rings) or acquired (e.g. post-intubation) tracheal stenosis, or extrinsic compression of the trachea (e.g. vascular anomalies) are present [27]. Other indications are persistent or recurrent atelectasis, persistent or recurrent localized pneumonia, localized wheezing, or pulmonary hyperinflation, or bronchiectasis, and history suggestive for foreign body inhalation. In these cases, bronchial obstruction (e.g. mucus plug, foreign body, or endobronchial tumor), stenosis (e.g. web), compression (e.g. from bronchogenic cysts, vessels, or lymph nodes), anatomical malformation, or bronchomalacia are the most frequent findings [25–27]. In case of mucus plug or foreign body bronchial obstruction, bronchoscopy is both diagnostic and therapeutic. While mucus plugs could be simply aspirated with flexible bronchoscopes, foreign bodies removal with flexible bronchoscopes should be tried only if there is the immediate possibility to switch to rigid bronchoscopy [28].
Related Knowledge Centers
- Croup
- Pharynx
- Pulmonary Aspiration
- Respiratory Tract
- Retropharyngeal Abscess
- Stenosis
- Stertor
- Tracheal Intubation
- Respiratory Sounds
- Epiglottitis