STRIDOR

1
STRIDOR

• ANNE ASPIN 2005

2
Common causes

• Laryngomalacia 60
• Congenital subglottic stenosis
• Vocal cord palsy - unilateral, birth trauma
  temporary
• Bilateral vocal cord palsy assoc other congenital
  anomalies

3
Morimoto et al (2004)

• 97 patients 1991-2001
• Laryngomalacia 32
• Vocal cord palsy and laryngeal stenosis 22,
  within 2/12, severe dyspnoea
• Haemangioma or papilloma 11
• Cystic disease 7

4
cont

• 2 / 31 of laryngomalacia and 2 / 22 VCP had
  neuromuscular disorders
• 3 of VCP complicated by laryngeal stenosis
• 33 / 97 Tracheostomy
• Sometimes stridor is the only presenting symptom.
  Past history important

5
Investigation

• Rigid or direct microlaryngoscopy general
  anaesthetic.
• Flexible fibre- optic laryngoscope, neonate awake
  (first line choice now)

6
Case history

• 6/12 girl
• Fever, coughing
• Inspiratory stridor
• Palpable neck swelling, bulging pharyngeal wall
• Limited movement of neck
• ? spasmodic croup, lymphadenitis coli
• Found to be retro pharyngeal abscess

7
Treatment

• Oral incision
• Drainage of abscess
• Antibiotics

8
Unilateral vocal cord paralysis

• Stridor
• Laryngospasm
• Dyspnoea
• Cause by abnormal innervation of nerve branches
  into adductor fibers

9
Cases

• Post Thyroid surgery
• Post cervical disc surgery
• After Herpes simplex virus with cranial nerve
  involvement
• Fire optic laryngoscopy showed affected vocal
  cord immobile

10
Treatment

• Laryngeal electromyography showed evidence of
  reduced but intact voluntary motor conduction in
  thyroarytenoid muscle.
• Botox injections

11
Research

• Objective
• Determine stridor at rest after oral Prednisolone
  1mg/kg
• And whether quick response after mild croup

12
Method

• Retrospective explicit chart review of children
  over 1 year of age admitted to a teaching
  hospital
• Patient demographics
• Croup scores at AE
• Duration of stridor at rest after steroids

13
Results

• 188 cases analysed
• Median duration at rest was 6.5 hrs, range 0.5
  hrs- 82 hrs
• Patients with low score at AE recovered quicker
  in response to steroids, early discharge home.

14
Amphotericin induced stridor

• Adverse effects reported Amphotericin B
• Dyspnoea
• Tachypnoea
• Bronchospasm
• Haemoptysis
• hypoxia

15
Objective

• To review mechanism of action and reports of
  respiratory adverse effects for Amphotericin B,
  the liposomal preparations for Amphotericin B and
  the differential diagnosis of stridor
• Medline search 1966 2002 looking for possible
  mechanisms and immunoregulatory effects of Ampho B

16
Results

• Amphotericin B shows increase in tumour necrosis
  factor alpha (TNF alpha) concentrations in
  macrophages.
• Induces prostaglandin E2 synthesis, increasing
  production of interleukin1 beta in mononuclear
  cells

17
Conclusion

• Amphotericin B induces production of TNF alpha,
  interferon gamma and interleukin 1 beta which
  have toxic effects.

18
Medicines for children

• Test dose infused over 30 mins 100mcg
• Renal impairment
• Low serum pott, mag, phos
• Lfts
• arrhythmias
• Pulmonary reactions if Amph and leucocyte Tx.