Version May 2024
| Cause | Typical age of presentation | Inspiratory stridor | Expiratory stridor* | Fever/toxic | Often recurrent | Other characteristics | ||||
| Neonate | Infants and toddlers (6 to 24 months) | Preschool (3 to 5 years) | School-aged | Adolescents | ||||||
| Acute or subacute onset | ||||||||||
| Viral croup (laryngotracheitis)¶ | X | X | + | +/– | URI symptoms, fever, cough, hoarseness. | |||||
| Spasmodic croup | X | X | + | X | Mild URI symptoms may be present. Symptoms typically occur at night and are intermittent, with abrupt and brief episodes within the same night or on successive nights. Recurrences are common. | |||||
| Bacterial tracheitis¶ | X | X | X | + | +/– | + | Among the most common airway emergencies requiring PICU admission. Most patients have prodromal symptoms of viral URI. | |||
| Epiglottitis | X | X | X | + | + | Without treatment, can progress rapidly to life-threatening airway obstruction. Young children classically present with respiratory distress, anxiety, and fever, often with dysphagia, drooling, muffled speech, and reluctance to lie flat. | ||||
| Retropharyngeal abscess | X | X | +/– | + | Sore throat progressing to fever, dysphagia, and muffled "hot potato" voice. | |||||
| Peritonsillar abscess | X | X | X | +/– | + | Usually preceded by tonsillitis or pharyngitis (eg, streptococcal), with muffled voice. | ||||
| Inducible laryngeal obstruction (vocal cord dysfunction or paradoxical vocal cord motion) | X | X | + | X | Typically presents with recurrent acute episodes of dyspnea and stridor; more pronounced with exercise and resolves during sleep. Patients may complain often of throat tightness, a choking sensation, dysphonia, and cough. | |||||
| Foreign body aspirationΔ | X | X | + | +/– | A history of a witnessed choking episode is common, but the acute symptoms often resolve and may not be immediately recalled by the caregiver. | |||||
| Anaphylaxis | X | X | X | X | + | +/– | Often associated with urticaria, choking, vomiting, and/or wheezing. | |||
| Airway burn | X | X | X | X | + | +/– | Due to thermal injury or caustic ingestion. | |||
| Postextubation | X | X | X | X | + | Common complication of endotracheal intubation for respiratory support, especially in small children. | ||||
| Therapeutic hypothermia | X | X | Multiple mechanisms, including prolonged intubation. | |||||||
| Chronic | ||||||||||
| Congenital anomalies | X | X | +/– | +/– | Congenital anomalies that cause stridor include laryngomalacia, tracheomalacia, subglottic stenosis, bronchogenic cysts, laryngeal malformations, hemangiomas, and vascular rings. These are outlined in a separate table. | |||||
| Vocal cord paralysis¶ | X | X | X | X | X | + | +/– | May be congenital, iatrogenic, or acquired (idiopathic or neurologic). Children with bilateral vocal cord paralysis typically present with stridor and respiratory insufficiency and may have normal voice/cry. | ||
| Subglottic stenosis | X | X | X | X | X | + | Can be acquired due to injury to the glottis after traumatic or prolonged endotracheal intubation in infants or can be a congenital anomaly | |||
| Tumor | X | X | X | X | X | +/– | +/– | Airway compression usually is extrinsic. Stridor symptoms depend on location of compression, but most are intrathoracic (eg, mediastinal) and extrinsic to the airway, which typically results in expiratory stridor. | ||
| Recurrent respiratory papillomatosis | X | X | + | +/– | X | Typically presents with chronic or progressive stridor, hoarseness of voice or weak cry, choking episodes, and cough, with wheezing if trachea is also involved. In some cases, upper airway obstruction may be life-threatening and may be the presenting symptom. | ||||
| Hypocalcemic laryngeal spasm | X | X | +/– | X | May be caused by severe hypocalcemia from any cause (eg, calcipenic rickets). The associated stridor can be chronic or intermittent but also may present with acute severe onset. | |||||
+: usually present; +/–: may or may not be present; PICU: pediatric intensive care unit; URI: upper respiratory tract infection.
* Any obstructive process that leads to a fixed airway narrowing will produce both inspiratory and expiratory noise.
¶ Onset either acute or subacute/gradual.
Δ Foreign body aspiration can occur in any age group but is most common in toddlers and preschool-aged children.آیا می خواهید مدیلیب را به صفحه اصلی خود اضافه کنید؟
