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Congenital stridor
G Lis1, T Szczerbinski, E Cichocka-Jarosz
1First Department of Pediatrics, Polish American Children's Hospital, Krakow, Poland.
Insights
Laryngomalacia, often caused by floppy arytenoid cartilages, is the most common cause of stridor in infants and children, affecting boys more frequently. These children often exhibit significant growth deficits.
Area of Science:
- Pediatrics
- Otolaryngology
- Respiratory Medicine
Background:
- Stridor in infants and children presents a diagnostic challenge.
- Identifying the etiology of stridor is crucial for effective management and prognosis.
Purpose of the Study:
- To investigate the causes of stridor in pediatric patients.
- To determine the prevalence and characteristics of laryngomalacia as a cause of stridor.
- To evaluate associated findings, such as growth deficits, in children with stridor.
Main Methods:
- Retrospective review of 52 infants and children presenting with stridor.
- Fiberoptic bronchoscopy utilized when initial diagnostic methods were inconclusive.
- Comparison of growth parameters (weight and height) with healthy populations.
Main Results:
- Laryngomalacia was the most frequent cause of stridor, identified in 65% of cases.
- Large, floppy arytenoid cartilages were the predominant form of laryngomalacia, seen more in boys.
- Children with laryngomalacia showed significant weight (24%) and height (8%) deficits.
- Non-laryngomalacia causes of stridor were diverse, necessitating specific etiological diagnosis.
Conclusions:
- Laryngomalacia, particularly due to floppy arytenoid cartilages, is the leading cause of pediatric stridor.
- Associated growth deficits are common in children with laryngomalacia.
- Accurate diagnosis of all stridor causes is vital for targeted treatment and improved outcomes.
Abstract:
Fifty-two infants and children with stridor were examined. The median age was 5 months and the boy/girl ratio was 2:1. Fiberoptic bronchoscopy was performed when other diagnostic methods had failed to establish the origin of stridor. The most common cause of stridor was laryngomalacia, which was found in 34 children (65%). The most common form of laryngomalacia was due to large, floppy arytenoid cartilages; this was observed twice as often as other forms of laryngomalacia and boys suffered from this abnormality more than twice as often as girls. Children with laryngomalacia had significant weight (24%) and height (8%) deficits in comparison with the normal healthy population (P < 0.001). In all but four patients with laryngomalacia, blood gases were within normal limits. In 18 children (35%) stridor was not caused by laryngomalacia. This group showed significant etiologic heterogeneity. However, identification of the cause of stridor in these patients is important because specific treatment can be offered and prognosis depends on the type and cause of the anatomical and functional abnormality present.