| خلاصه مقاله | Noisy breathing describes a high-pitched or low-pitched, monophonic or biphasic sound made when breathing that is best heard over the anterior neck. Stridor is caused by the oscillation of a narrowed airway, and its presence suggests significant obstruction of the large airways. In patients with minor degrees of airway narrowing the stridor may occur only during activity.
Inspiratory stridor: In general, stridor originating from obstruction in the extrathoracic region is more pronounced during inspiration, when the pressure inside the airway falls below atmospheric pressure, causing airway collapse.
Expiratory stridor: In contrast, stridor originating from obstruction in the intrathoracic region is more pronounced on exhalation, since intrathoracic pressure rises on expiration and causes airway collapse.
Biphasic stridor: A fixed central airway obstruction usually produces noise on both inspiration and expiration.
Stertor or snoring: If airway narrowing originates from the nasal, nasopharyngeal, or oropharyngeal areas, the noise generated is typically low pitched.
Stridor may result from a variety of conditions that can be either congenital or acquired.
Cause of stridor: Acute onset (eg, Foreign body aspiration, Anaphylaxis, Infectious causes, Airway burns); Subacute onset (eg, Laryngotracheitis
Retropharyngeal abscess, Peritonsillar abscess); Chronic/recurrent (eg, Congenital: Laryngomalacia, Tracheomalacia, Vocal cord paralysis, Vascular ring, Bronchogenic cyst, Laryngeal malformations, Infantile hemangiomas, Subglottic stenosis. Acquired: Vocal cord dysfunction or paradoxical vocal fold motion, Recurrent respiratory papillomatosis, Vocal cord paralysis, Subglottic stenosis, Hypocalcemic laryngeal spasm, Tumor).
Visualization of the airways with nasopharyngoscopy, laryngoscopy, and bronchoscopy allows definitive diagnosis of the cause of stridor in children. More than one airway abnormality may be present in the same child, and a thorough evaluation of the upper and lower airways may be warranted., |