Noisy Breathing (Stridor) - Atlanta Children's ENT

Noisy Breathing (Stridor)

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1.	What Is Stridor?
2.	What Causes Stridor?
3.	How Is Stridor Diagnosed?
4.	How Is Stridor Treated?
5.	What Is Wheezing?
6.	What Is Croup?

1.	What Is Stridor?
	Many children make various noises while breathing. The term stridor refers to a specific high-pitched airway noise usually noted during inspiration. Stridor is often described as a "crowing" noise and occurs in approximately 10% of newborn infants.
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2.	What Causes Stridor?
	Narrowing or partial blockage of the voicebox and/or trachea results in stridorous breathing. The most common cause of stridor in newborns is collapse of the soft cartilages of the voicebox called laryngomalacia. The floppy walls of the voicebox fall inward upon inspiration resulting in noisy breathing. Other causes of newborn stridor include weakness or paralysis of one or both vocal cord of narrowing of the upper windpipe (subglottic stenosis.) Stridor may also occur anytime after birth. Sudden onset of stridor following a severe coughing or choking episode may indicate that a foreign object such as peanuts, popcorn, or small toy parts has entered the voicebox or windpipe. Infectious causes of stridor are croup or epiglottitis. Stridor is a symptom, which indicates narrowing of the airway. Mild or partial obstruction of the breathing passages may result in few symptoms other than intermittent stridor. More severe narrowing results in louder stridor associated with signs of breathing difficulty: 1. Bluish discoloration of lips or fingers 2. Heavy chest movements 3. In-drawing of notch at the base or space between the ribs 4. Anxiousness or agitation 5. Inability to suck a bottle or breast 6. Persistent cough 7. Vomiting 8. Shortness of breath
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3.	How Is Stridor Diagnosed?
	The cause of stridor is usually apparent after a thorough history and office examination of the child. A stethoscope can be used to listen over the voicebox and windpipe to determine the location of the noise. A flexible telescope may be inserted through the nose or mouth to visualize the voicebox to assess vocal cord movement and size of the airway. Floppy tissues of the voicebox may collapse while the child is breathing or collapse or the upper airway.
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4.	How Is Stridor Treated?
	Treatment of stridor depends on the cause. Mild laryngomalacia usually persists until 12 months of age and gradually resolves during the second year of life. Severe laryngomalacia may be associated with the inability to feed and breathe adequately. In these cases, a surgical procedure can be used to release the floppy cartilage of the larynx (epiglottoplasty) and therefore reduce collapse of the airway. One of the potential life threatening causes of stridor is aspiration of a foreign object into the breathing passageways. Children ages 6 months to 4 years are at greatest risk. Often the symptoms may be quite subtle and the condition goes undiagnosed. The diagnosis and subsequent removal of the foreign object may require a telescopic examination of the voicebox (laryngoscopy) and windpipe (bronchoscopy) under general anesthesia in the operating room. Overall the prognosis for children with stridor is very good. Most of the time the symptoms is temporary and resolving over days to years depending on the cause. Prompt examination and accurate diagnosis by a skilled physician is crucial.
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5.	What Is Wheezing?
	Another frequently diagnosed airway sound is wheezing. Stridor and wheezing are occasionally confused. Wheezing usually originates from the lungs and is heard during expiration. Wheezing may indicate spasm of the breathing passageways or asthma. It is important to distinguish these two airway sounds, as each requires different treatment.
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6.	What Is Croup?
	Croup is a viral illness usually affecting children 3 months to 3 years. There is a seasonal distribution with increased incidents in the late fall and early winter. Croup usually follows a recent cold-like illness. A harsh barking cough may progress to severe stridor. The diagnosis is made based on the history and progression of the illnesses and office examination. X-rays may be helpful. Treatment involves cool mist or high humidity (steamy shower), fluids, and anti-inflammatory agents such as steroids. Occasionally hospitalization is necessary. Typical croup resolves in 3-7 days. Epiglottitis is the most serious form of croup syndrome seen in ages 3-7. There is no seasonal predilection. The onset of symptoms of stridor and respiratory diseases progresses rapidly, often within hours. The infectious agent most responsible is Hemophilus influenza Type B. Once the diagnosis is made, steps must be taken to place an artificial airway (intubation or tracheostomy) in the child and administer intravenous antibiotics. Once symptoms subside, usually within 24-72 hours, the airway can be removed. Mortality from undiagnosed epiglottitis can be as high as 50%.
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