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Inspiratory and expiratory stridor in a 13-month child with croup.
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Stridor (Latin for "creaking or grating noise") is a high-pitched breath sound resulting from turbulent air flow in the larynx or lower in the bronchial tree. It is not to be confused with stertor which is a noise originating in the pharynx. Stridor is a physical sign which is caused by a narrowed or obstructed airway. It can be inspiratory, expiratory or biphasic, although it is usually heard during inspiration. Inspiratory stridor often occurs in children with "croup." It may be indicative of serious airway obstruction from severe conditions such as epiglottitis, a foreign body lodged in the airway, or a laryngeal tumor. Stridor should always command attention to establish its cause. Visualization of the airway by medical experts equipped to control the airway may be needed.
The first issue of clinical concern in the setting of stridor is whether or not tracheal intubation or tracheostomy is immediately necessary. A reduction in oxygen saturation is considered a late sign of airway obstruction, particularly in a child with healthy lungs and normal gas exchange. Some patients will need immediate tracheal intubation. If intubation can be delayed for a period, a number of other potential options can be considered, depending on the severity of the situation and other clinical details. These include:
In obese patients elevation of the panniculus has shown to relieve symptoms by 80%.
Stridor may occur as a result of:
Stridor is usually diagnosed on the basis of history and physical examination, with a view to revealing the underlying problem or condition.
Flexible fiberoptic bronchoscopy can also be very helpful, especially in assessing vocal cord function or in looking for signs of compression or infection.
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