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Paediatric stridor
  1. S Majumdar,
  2. N J Bateman,
  3. P D Bull
  1. Royal Hallamshire Hospital, Sheffield, UK
  1. For correspondence:
    Mr Sam Majumdar
    Department of Otolaryngology and Head & Neck Surgery, Sheffield Teaching Hospital, Royal Hallamshire Hospital, Sheffield, S10 2JF, UK; sammajumdar{at}doctors.org.uk

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Stridor can be defined as a high-pitched noise resulting from turbulent airflow through a partially obstructed upper airway. It may be associated with any phase of respiration, therefore, monophasic or biphasic, inspiratory or expiratory. Any obstruction at the level of the glottis or of the subglottis causes inspiratory stridor. Supraglottic obstruction will usually cause either stridor or more commonly stertor, a low pitched snoring type of noise. Obstruction of the extrathoracic trachea tends to cause biphasic stridor while obstruction of the intrathoracic trachea usually causes expiratory stridor. Partial obstruction of the upper airway at the nasopharyngeal or oropharyngeal level produces stertor. This is frequently associated with sleep. Stertor must be differentiated from true stridor. A stridor misdiagnosed for stertor will disguise the underlying cause and put the airway at risk of developing complete obstruction.

Stridor is a serious clinical sign that warrants immediate attention. The primary task in managing a child with stridor is to assess and secure the airway. Once the child has been protected from impending loss of airway, a thorough and structured history with appropriate investigations will reveal the underlying pathology. Management of the child will be determined by that pathology.

MECHANISM OF STRIDOR

There are certain differences between the adult and paediatric airway which affect the presentation of children with airway problems.1 In the neonate, the larynx is placed high in the neck. The tip of the epiglottis is at the level of the atlas and the cricoid cartilage lies at the level of the fourth cervical vertebra. The close apposition of the epiglottis to the soft palate aids suckling, but makes nasal breathing obligatory. The thyroid cartilage is partly contained within and slightly inferior to the hyoid bone. This makes the laryngeal skeleton compact. Newborns have a short epiglottis and prominent arytenoids. As the larynx grows, the …

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