a harsh, low-pitched, vibratory sound associated

with obstruction of the laryngeal area or the

extrathoracic trachea
Produced by rapid, turbulent flow of air through a
narrowed segment of the upper respiratory tract
usually inspiratory but may be
expiratory/biphasic
most commonly observed in children with croup;
foreign bodies and trauma can also cause acute
stridor
Inspiratory stridor suggests an extrathoracic
lesion (eg, laryngeal, nasal, pharyngeal)
Expiratory stridor implies an intrathoracic lesion
(eg, tracheal)
Biphasic stridor suggests a subglottic or glottic
anomaly
The louder the stridor, the worse is the
obstruction
STRIDOR WHEEZING
 Inspiration phase  Expiration phase
 Prolong inspiration >  Prolong expiration >
expiration inspiration
 Extrathoracic airway  Intrathoracic airway
obstruction obstruction

Extrathoracic -nose to midtrachea

 STRIDOR
 Variable phase: inspiratory
or expiratory / biphasic
 air flow changes within the
larynx, trachea or bronchi
 sound produced ranges
from low pitched to high
pitched frequencies
 Stridor is infact more often
musical in character.
 May associated with
hoarseness of
voice/barking cough
 STERTOR
 Mostly in inspiratory
phase
 obstruction of airway
above the level of the
larynx
 It is low pitched snoring
or snuffly sound
 produced by vibrations of
tissue of the naso pharynx,
pharynx or soft palate
 Usually no hoarseness of
voice/barking cough
Nose and pharynx Larynx Trachea
• Laryngomalacia
 Choanal atresia  Tracheomalacia
• Laryngeal web, cyst or
 thyroglossal cyst laryngocele
• Laryngotracheobronchitis
 Macroglossia (viral croup) Bacterial
 • Acute Epiglottitis
Hypertrophic tonsils/adenoids tracheitis
 Retropharyngeal abscess • Vocal cord paralysis
• Laryngotracheal stenosis  External
 peritonsillar abscess
• Cystic hygroma compression
• Foreign body
• Subglottic hemangioma
• Laryngeal papilloma
 STRIDOR

CONGENITAL ACQUIRED

1. C. Web
2. C. subglottic stenosis
3. Supraglottic Cyst
APYREXIAL PYREXIAL
4. Laryngomalacia
5. V/C palsy 1. A. subglottic stenosis 1. Acute
6. Vascular anomaly 2. FB epiglottitis
7. Micrognathia 3. Trauma 2. Acute laryngitis
8. Cleft larynx 4. Scald/ burns 3. Acute
9. Lymphangioma 5. Recurrent resp papillomatosis laryngotracheo
10. Haemangioma 6. Enlarged tonsils, adenoids - bronchitis
(croup)
4. Diphteria
5. Retropharyngeal
abscess
SIGN EXTRATHORACIC INTRATHORACIC- INTRAPULMONARY PARENCHYMA
EXTRAPULMONAR
Y
TACHYPNEA + + ++ ++++

RETRACTION ++++ ++ ++ ++

STRIDOR ++++ ++ - -

WHEEZING +/- +++ ++++ +/-

GRUNTING +/- +/- ++ ++++

 Onset: day / night / very acute onset: Foreign Body
 Duration : chronicity
 Characteristic : stridor / snoring / wheezing
 Severity : sign of respiratory distress
 Precipitating factor: feeding / crying / exercise
 Preceding URTI sx? Yes: croup No: epiglotitis
 Associated symptoms:
 fever , cough , drooling of saliva , hoarsness of voice ,
choking, leaning forward

 Maternal history
 HPV infection
Birth history
 Any history of respiratory distress requires
endotracheal intubation : subglotic stenosis
Feeding history
 Poor feeding
 History of choking
Immunization history
 Hib vaccination
Family history
 Any other sibling had similar symptom / chronic
respiratory problem
Onset over hours
Toxic, very ill appearance
No preceding coryza
High grade fever(>38.5°C)
Absent / slight cough
Leaning forward
Soft stridor
Muffled, reluctant to speak
Can’t drink & drooling of saliva
General
 Level of conciouness
 Cyanosis
 Sign of respiratory distress
 Hydration status
 Vital signs
Throat: injected / enlarged tonsil
Oral / nasal cavity
Respiratory system
 Peripheral sign: cyanosis, clubbing, bounding pulses
 Nose: nasal flaring, hypertrophied nasal turbinate, nasal
secretion
 Central cyanosis, hoarseness of voice, barking cough
 Recession , chest deformity
 Transmitted sound, rhonci, crepts
CVS
 Tachycardia
CNS
 Agitated, drowsy, unconciousness
Assessment of airway
Head tilt-chin lift
Intervention
 Removal of foreign body
 Oral / nasal airway
 Intubation:
apnea
airway obstruction unrelieved by airway-opening maneuvers
increased work of breathing that may lead to fatigue
need for positive end-expiratory pressure
 tracheostomy
Assessment of breathing
 Look : chest rise/fall
 listen : mouth breathing
 Feel : air existing in airways
Intervention
 2 rescue breathing over 1 sec: place mouth over infant’s
mouth and nose
Removal of Foreign Body Airway obstruction
 Perform 5 back blows and 5 chest thrust
 Clinical syndrome characterize by barking cough,
inspiratory stridor, hoarseness of voice and respiratory
distress of varying severity
 Viral Infection of larnyx, trachea and bronchi
 Most common pathogen : Parainfluenza virus (74%)
 Symtoms:
 Rhinorrhea, pharyngitis, mild cough, low grade fever for 1-3
days before sign and symptom of upper airway obstruction
occur
 Barking cough, hoarseness of voice and inspiratory stridor
 May worse at night
 Aggravated by agitation and crying
 Child may prefer sit up in the bed / held upright
Mild: stridor with excitement or at rest, no
respiratory distress

Moderate: stridor at rest with Intercostal, subcostal

and sternal recession

Severe: stridor at rest with marked recession,

decrease air entry and altered level of consciousness
Moderate-severe croup
Poor oral intake
Live long distance from hospital
Less than 6 months
Toxic looking
Indication for oxygen therapy
Severe viral croup
Percutaneous Sao2<93%

Antibiotics are not recommended unless bacterial

super impose infection is strongly suspected / patient
very ill
It is an acute life threatening
illness (medical emergency)

Cause by H. influenza type b. rare

since Hib immunization.

Mostly aged 1-6 years

High fever, ill, toxic looking child
An intensely painful throat that prevents the child
from swallowing or speaking.
Typically prefer to sit upright breathing from the
mouth, constantly drooling of saliva.
Soft inspiratory stridor
The diagnosis is based on the clinical history, the
signs of toxaemia and upper airway obstruction.
 Management
Urgent hospital admission
Tracheostomy or endotracheal intubation
Intravenous antibiotic
eg; ceftriaxone / cefotaxime / unasyn for 7-10 days
Mortality is high as the diagnosis is delayed
With appropiate treatment, most children recover
completely within 2-3 days.
Croup
 Onset over days
 Appearance unwell
 Preceding coryza
 Low grade fever
 Severe, barking-like cough
 Harsh stridor
 Hoarse voice
 Can drink and no drooling
of saliva
Epiglotittis
 Onset over hours
 Toxic,very ill appearance
 No preceding coryza
 High grade fever(>38.5°C)
 Absent @ slight cough
 Soft stridor
 Muffled, reluctant to speak
 Can’t drink & drooling of
saliva