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Etiology of stridor in the neonate, infant and child
Insights
Congenital anomalies are the primary cause of stridor in infants, often requiring early endoscopy for accurate diagnosis. Complete examination is crucial due to the high incidence of multiple anomalies.
Area of Science:
- Pediatric Otolaryngology
- Congenital Anomalies
- Respiratory Disorders
Background:
- Stridor is a significant respiratory symptom in infants.
- Congenital anomalies are frequently implicated in pediatric stridor.
- Accurate and timely diagnosis is essential for effective management.
Purpose of the Study:
- To investigate the causes of stridor in pediatric patients.
- To determine the diagnostic yield of endoscopy in stridor evaluation.
- To highlight the prevalence of congenital anomalies and associated conditions.
Main Methods:
- Retrospective review of 219 pediatric patients presenting with stridor.
- Analysis of presenting symptoms, age, sex, and diagnosed conditions.
- Classification of anomalies based on anatomical location (laryngeal, tracheal, bronchial).
- Evaluation of diagnostic timelines and treatment outcomes, including tracheotomy rates.
Main Results:
- Congenital anomalies caused stridor in 87.2% of patients.
- Congenital laryngeal anomalies were the most common cause (60.3%).
- Multiple anomalies were present in 45.2% of cases.
- Endoscopic diagnosis was delayed by an average of four months.
- 26.5% of patients received incorrect initial diagnoses.
Conclusions:
- Congenital anomalies are the predominant etiology of stridor in young children.
- Early and comprehensive endoscopic evaluation is critical for accurate diagnosis.
- The high rate of multiple anomalies necessitates thorough examination of the entire tracheobronchial tree.
Abstract:
Of 219 patients whose primary presenting symptom was stridor, 150 were males, 69 were females. All were under 2 1/2 years of age; more than half were four months of age or younger. Congenital anomalies caused stridor in 191 (87.2%). Congenital laryngeal anomalies accounted for the stridor in 132 (60.3%); there were 35 (16.0%) patients with congenital tracheal anomalies, 11 (5.0%) with congenital bronchial anomalies, 12 (5.5%) with infectious conditions, 12 (5.5%) with internal laryngeal trauma and 15 (6.8%) patients with other conditions. The cause of stridor was undetermined in two patients. Sixteen vascular anomalies were diagnosed and classified according to the part of the tracheobronchial tree which was involved. Twenty-six patients required tracheotomy. Fifty-eight (26.5%) were referred with an erroneous presumptive diagnosis for which they were being treated. The mean length of time from onset of symptoms to determination of the correct diagnosis by endoscopy was four months; it varied from one day to 16 months. The importance of early endoscopy for the diagnosis of conditions causing stridor cannot be overemphasized. The occurrence of more than 1 anomaly in 99 (45.2%) of the 219 patients demonstrates the importance of complete endoscopic examination of all patients with stridor.