xRead - February 2023

Stridor in the Infant Patient

307

Table 2 Differential diagnosis of airway obstruction based on location and age of the child

Birth to 1 year old

1–3 years old

3–6 years old

Adenotonsillar hypertrophy Adenoiditis Allergic rhinitis Foreign body

Adenotonsillar hypertrophy Allergic rhinitis Foreign body Foreign body Recurrent respiratory papillomatosis

Nasopharynx

Choanal atresia/stenosis Craniofacial abnormalities Piriform aperture stenosis Nasal stenosis Neonatal rhinitis Laryngomalacia Congenital cysts Laryngeal webs Vocal cord palsy Subglottic stenosis (congenital & acquired) Laryngeal cleft Subglottic hemangioma Reflux laryngitis Tracheomalacia Tracheal stenosis Vascular compression

and pharynx

Recurrent respiratory papillomatosis Foreign body Epiglottitis

Larynx

Trachea

Croup Bronchiolitis Foreign body

Foreign body

( Fig. 4 ). Saccular cysts are similar to mucous retention cysts but can arise anteriorly to protrude within the laryngeal ventricle or laterally to extend into the false vocal cord and aryepiglottic folds. Symptoms of both conditions are dependent on size of the supraglottic cyst, which corresponds to respiratory distress severity. Subglottic cysts can mimic the stridulous presentation of subglottic hemangioma or subglottic steno sis. 21 Intubation or manipulation of the larynx is thought to be the most common cause, with 1 study finding 100% of patients who had this condition had been intu bated during the neonatal period. 22 When symptomatic, treatment of this condition with marsupialization is typically performed with electrocautery, microdebrider, laser, or other microlaryngeal instrumentation. Recurrence is common, and these patients should be monitored for a period until symptoms subside. Recurrent respiratory papillomatosis (RRP) develops in infancy and childhood in pa tients exposed to human papillomavirus (HPV) type 6 and 11 at birth ( Fig. 5 ). This is the most common laryngeal neoplasm in children resulting in stridor. Despite early expo sure, papillomas typically develop between the ages of 2 and 4 years old but can

Fig. 3. Subglottic masses, such as a hemangioma ( A ) and hamartoma ( B ).

Downloaded for Anonymous User (n/a) at Geisinger Health from ClinicalKey.com by Elsevier on November 28, 2022. For personal use only. No other uses without permission. Copyright ©2022. Elsevier Inc. All rights reserved.