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Laryngeal dyskinesia as a cause of stridor in infants
F Denoyelle1, E N Garabedian, G Roger
1Department of Pediatric Otolaryngology and Cervicofacial Surgery, Armand Trousseau's Children's Hospital, Paris, France.
Insights
Infants with inspiratory stridor may have laryngeal dyskinesia, a condition where vocal cords fail to abduct. This often co-occurs with gastroesophageal reflux and typically resolves by 13 months.
Area of Science:
- Pediatric Otolaryngology
- Pediatric Pulmonology
- Neonatal Medicine
Background:
- Inspiratory stridor in infants can be caused by various conditions.
- Vocal cord dysfunction is a potential, though less common, etiology.
- Differentiating stridor causes is crucial for appropriate management.
Purpose of the Study:
- To describe a series of infants presenting with stridor.
- To characterize a condition termed 'laryngeal dyskinesia' characterized by vocal cord abductor failure.
- To explore potential associations with other medical conditions.
Main Methods:
- A case series of 9 hospitalized infants aged 1-13 months.
- Clinical evaluation for inspiratory stridor.
- Exclusion of true vocal cord paralysis through assessment of glottic motion.
- Association with gastroesophageal reflux and vagal hypertonia investigated.
Main Results:
- All 9 infants exhibited inspiratory stridor due to laryngeal dyskinesia.
- Gastroesophageal reflux was present in 8 cases.
- Vagal hypertonia and fainting spells were noted in 3 infants.
- Stridor resolved spontaneously in 7 infants between 4 and 13 months of age.
Conclusions:
- Laryngeal dyskinesia appears to be a distinct clinical entity in infants.
- This condition is frequently associated with gastroesophageal reflux.
- The natural course suggests spontaneous resolution in most cases.
Objective:
To describe 9 cases of stridor attributed to the failure of the vocal cord to abduct during inspiration.
Design:
Case series.
Setting:
Pediatric otolaryngology referral center.
Patients:
Nine hospitalized infants, aged 1 to 13 months, presented over a 3-year period for exploration of inspiratory stridor that was attributed to a condition that we have termed laryngeal dyskinesia.
Results:
A consistent clinical presentation was noted in all cases. The laryngeal dyskinesia occurred during calm breathing, crying, or sleep and was associated with gastroesophageal reflux in 8 cases (diagnosed clinically and/or with pH monitoring). In addition, 3 infants suffered from fainting spells associated with vagal hypertonia that was confirmed by 24-hour Holter monitoring. True paralysis of the abductor muscles was ruled out in all infants because of the presence of normal glottic motion during calm breathing or induction of anesthesia. The stridor resolved between the ages of 4 and 13 months in 7 of the patients. Improvement was progressive and had no clear relationship to treatment for gastroesophageal reflux.
Conclusion:
Laryngeal dyskinesia in infants seems to be a distinct clinical entity, frequently associated with gastroesophageal reflux.