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St r idor in the Infant Pat ient

Habib G. Zalzal, MD a, *, George H. Zalzal, MD a

KEYWORDS Stridor Laryngomalacia Supraglottoplasty Pediatric airway Congenital laryngomalacia

KEY POINTS

Stridor is defined by the harsh respiratory noise that develops owing to turbulent airflow through a restricted passage. Several conditions cause stridor, but laryngomalacia is the most common cause of inspi ratory stridor in neonates and infants. Treatment of laryngomalacia depends on severity of symptoms, but most patients can be observed and will not need surgical intervention. Surgical treatment of severe laryngomalacia involves removal and release of collapsing supraglottic tissue with excellent results.

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INTRODUCTION

Stridor is a harsh respiratory noise caused by turbulent airflow through a restricted passage. At baseline, stridor is a pathologic clinical sign that should prompt a thor ough investigation by the physician. Inspiratory stridor results from upper-airway obstruction resulting in prolonged inspiration in a minority of patients. Expiratory stri dor, by contrast, results from lower-airway obstruction with patients exhibiting pro longed expiration. Biphasic stridor is a combination of both inspiratory and expiratory respiratory noise and typically corresponds to an obstruction in the midtra cheal anatomy between the upper and lower airways. Depending on the severity of the stridor, patients may show signs of respiratory distress, including dyspnea, nasal flar ing, intercostal or subcostal retractions, grunting, cyanosis, somnolence, periods of apnea, and brief resolved unexplained events (BRUEs, formerly known as acute life threatening events or ALTEs).

The authors deny any conflict of interests or funding sources associated with this article. a Division of Otolaryngology, Children’s National Medical Center, 111 Michigan Avenue, Northwest, Washington, DC 20010, USA * Corresponding author. E-mail address: hzalzal@cnmc.org

Pediatr Clin N Am 69 (2022) 301–317 https://doi.org/10.1016/j.pcl.2021.12.003

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