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An extremely rare laryngeal hamartoma causing inspiratory stridor in a 6-week-old infant is reported and the histology discussed. The tumor is benign and responds to simple excision. No other cases have been found in the 20th century American literature.
In the elective evaluation of infant stridor, inspiratory plain radiographs of the neck and chest are routinely obtained with fluoroscopy and a barium swallow when indicated. Several factors, including patient positioning, roentgenographic technique, and the phase of respiration, may significantly alter the appearance of the airway, reducing the diagnostic accuracy of this modality and leading to misinterpretation of the pathologic changes.
A 10-year, 11-month-old boy who had had chronic stridor since birth died suddenly following the development of slowly progressive symptoms of respiratory obstruction due to vocal cord paralysis. Autopsy showed extensive bilateral syringobulbia, with the greatest involvement in the nuclei ambigui. Other brain-stem tracts and nuclei were only partially affected. These findings support the theory of the early developmental origin of syringobulbia.
We present a patient with multiple myeloma whose only presenting symptom was stridor caused by a subglottic stenosis. Biopsy suggested the presence of amyloid which prompted immunological investigations that showed hypogammaglobulinaemia and the presence of Bence Jones proteinuria at 0.93 g/24 hours. Further investigation demonstrated a 15 per cent plasma cell infiltrate into the bone marrow and a lytic lesion in the mid-shaft of the right femur. Chemotherapy and localized radiotherapy were commenced. This is a most unusual presentation of multiple myeloma and shows that immunoglobulin profiles should be properly investigated in such cases.
Most laryngeal anomalies are supraglottic and laryngomalacia is the most common. Cysts, bifid epiglottis and absence of the epiglottis are uncommon. An 18-year-old Caucasian man had long-standing stridor caused by anomalous supraglottic structures: a small floppy epiglottis, enlarged accessory cartilages and redundant aryepiglottic folds. These structures were excised and the airway was improved. The ventral portions of the fourth arches become the aryepiglottic folds and lateral segments of the epiglottis. A disturbance in this portion of the fourth arch may explain the anomaly. The cartilaginous contributions to the epiglottis were possibly isolated as accessory cartilages. Epiglottic anomalies may be associated with other anomalies, especially the digits of the hand. This patient had a short lingual frenulum and mild macroglossia.
This is a report of seven patients with various degrees of stridor and airway obstruction due to redundancy of the aryepiglottic folds. This condition appears to be acquired and is most likely caused by central nervous system pathology which disrupts the normal neuromuscular function of the larynx.
Vocal cord paralysis or paresis as the initial presenting symptom for intracranial tumors in children are rare. Recently, two pediatric patients who were later diagnosed as having intracranial tumors presented with the symptom of voice changes and stridor. Telescopic examination revealed bilateral vocal cord paresis and paralysis as demonstrated by video recordings. The majority of pediatric brain tumors present with both generalized and localized complaints; however, by discussing these two rare cases, we hope to underscore the importance of a thorough workup of the paralyzed or paretic vocal cords.
Diaphragmatic flutter is a rarely reported disorder in which the diaphragm involuntarily contracts at a rapid rate. We report a unique case in which diaphragmatic flutter was associated with inspiratory stridor and was severely disabling. A new approach to the treatment of this condition, phrenic nerve crush, provided an optimal outcome, with resolution of symptoms and the return of normal diaphragmatic function. Pathophysiology and treatment of this condition are discussed.
STUDY OBJECTIVES: Diagnosis and medical intervention for exercise-induced bronchospasm (EIB) are often based on self-reported symptoms, without spirometric confirmation. Inspiratory stridor (IS), a symptom of vocal cord dysfunction (VCD), is frequently mistaken for EIB wheeze. Athletes with exercise IS that spontaneously resolves on activity cessation are suspect for VCD and may not have EIB. This study estimated IS prevalence in elite athletes and determined its relationship to EIB. SUBJECTS/METHODS: Three hundred seventy athletes (174 female and 196 male subjects) provided a medical history, and underwent spirometry before and after exercise challenge. Exercise challenges were conducted in cold, dry ambient conditions. EIB positive (EIB +) was defined as a > or = 10% postexercise fall in FEV(1). Athletes were monitored for IS during exercise; 78.4% of the athletes in this study (n = 290) were tested on multiple occasions. RESULTS: EIB was identified in 30% of 370 athletes tested (58 female and 53 male subjects). IS was observed in 5.1% (18 female and 1 male subjects) during exercise and spontaneously resolved in these subjects within 5 min after exercise cessation. Ten IS-positive (IS +) athletes (52.6%) were EIB +, and 8 of these athletes had a previous EIB diagnosis; however, beta(2)-agonist treatment resolved IS in only 2 subjects. Eight of nine IS +/EIB-negative (EIB -) athletes had a previous EIB diagnosis; seven subjects received beta(2)-agonist treatment with no IS resolution. Resting spirometric measurements did not distinguish IS, but postexercise mid-flow (FEF(50)/FIF(50)) ratio > 1.5 was more frequent (33%, p < 0.05) among IS + athletes. The FEF(50)/FIF(50) ratio was higher for IS +/EIB + athletes than for IS -/EIB + athletes (1.97 +/- 1.69 vs 0.81 +/- 0.39, p < 0.05). The postexercise fall in FVC was greater (p < 0.05) for IS +/EIB - athletes (9.2 +/- 5.0%) than for IS-negative (IS -) /EIB - athletes (5.3 +/- 4.3%). No difference in postexercise FEV(1) was identified between IS + and IS - athletes (within EIB + or EIB - groups). CONCLUSIONS: Five percent of athletes were IS +, with EIB comorbidity observed in 53% of these subjects. Misdiagnosis of IS as EIB is common. The lack of a beta(2)-agonist response in combination with postexercise serial spirometry can be useful in excluding solitary IS and confirming EIB diagnosis.
Approximately 20% of mechanically ventilated patients experience post-extubation stridor (PES) and reintubation, which subsequently may lead to an increased risk of morbidity and mortality. The risk of PES development is significantly higher in obese patients. Low air leakage between the endotracheal tube and the trachea, following cuff deflation, may indicate a higher risk for the development of PES. The aim of this study is to identify the relationship between body mass index (BMI) and PES using the cuff-leak test in patients intubated in the respiratory intensive care unit. A total of 67 consecutive intubations on 56 different ventilated patients were included in this study. The mean age was 63.6 +/- 12.1 years and 84% of the patients were male. PES developed in seven patients (10.4%). The mean cuff-leak volume was 395 +/- 187 ml in non-PES patients and 240 +/- 93 ml in PES patients (p = 0.023). The mean BMI was 36 +/- 13 kg/m2 in PES patients and 24 +/- 7 kg/m2 in non-PES patients (p = 0.046). BMI > 26.5 kg/m2 (OR: 1.2), low cuff-leak volume (< 283 ml) and mechanical ventilation required for more than 5 days (OR: 0.9) were independent variables for PES occurrence. We therefore suggest that non-obese patients, short-term intubated patients and those having a high air leakage around the endotracheal tube could be extubated without much difficulty.
A 17-year-old boy was seen in the emergency department with signs and symptoms of acute upper airway obstruction, closely resembling epiglottitis. Immediate management consisted of induction of general anesthesia with spontaneous ventilation. Because no organic pathologic process was found, and in combination with subsequently known psychosocial stressors, a diagnosis of psychogenic stridor, a conversion disorder, was made. Conversion disorders may be seen by the busy family practitioner or pediatrician and are frequently underdiagnosed.
A 71-year old man who had had severe rheumatoid arthritis for many years involving all the joints suddenly developed stridor caused by immobilisation of both the vocal cords. Arthritis of the cricoarytenoid joints of the larynx was suspected, and the patient was successfully treated with prednisolone.
We report an unusual presentation of non-Hodgkin's lymphoma of the thyroid which mimicked an acute infective thyroiditis and was associated with acute stridor and dysphagia. The mode of presentation and diagnosis of thyroid lymphoma are discussed and the value of early fine needle aspiration emphasised.
Guidelines for the clinical investigation of young children with stridor and sleep apnea are presented. Clinical examination and flexible videolaryngoscopy performed in local anaesthesia are the most important diagnostic tools for this group of children. If the impairment is severe or an objective evaluation is needed the child should also undergo nocturnal polygraphic recording and lung function tests. Out of 43 children examined with flexible videolaryngoscopy 21 had positive findings, laryngomalacia being the most common diagnosis. Flexible videolaryngoscopy is a good complement to laryngoscopy under general anaesthesia. It can be performed as early as in the neonatal period.
We report a case of a 12-month-old infant who developed acute respiratory distress with stridor from an impacted proximal esophageal foreign body. She was treated inappropriately as upper respiratory infections prior to the validation of the presenting complaint. Difficulties in diagnosis of esophageal foreign bodies arise, when the patient presents with atypical symptoms. Clinical suspicion remains the most important aid to diagnosis and endoscopic examination is essential for the diagnosis and successful management of foreign bodies in the esophagus.
Aberrant left pulmonary artery is a rare cause of stridor and respiratory difficulty in infancy and childhood. Diagnosis can be made on oesophagram, and is confirmed conclusively on angiography. Surgery can be curative, especially in cases without severe associated cardiovascular anomalies. A case report is presented of the condition occurring in a South African Black infant.
Stridor is frequently encountered in the pediatric age group and can be alarming to the parents. Many lesions and abnormalities can cause it and the challenge is to pinpoint a specific diagnosis effectively. The patient is usually referred to the pediatric otolaryngologist by the primary care physician who should be aware of the different lesions to avoid any delay in proper management. In the operating room, both the anesthesiologist and the surgeon should cooperate to reach a proper diagnosis or in the extreme situation save the life of the baby.
We describe the case of a 10-day-old boy who was brought to the hospital with stridor and respiratory distress. He was diagnosed with stenosis caused by a subglottic cyst. After the cyst was removed endoscopically, the patient's symptoms resolved. Pathology identified the cyst as ectopic thymic tissue. This case is noteworthy because we believe it represents the first reported instance of ectopic thymic tissue in the subglottis.