Pediatria pre prax 4/2017

Stridor in child from the perspective of otorhinolaryngologist

Background. Stridor is a common clinical symptom in children. The most common cause of inspiratory as well as inspiratory-expiratory stridor is a laryngeal disease, most specifically laryngomalacia occurring in 45 – 75% of cases. Determination of the correct diagnosis in children is rather difficult because of variety of etiology. The main goal of our work is to provide a complex overview of laryngeal diseases in children and their correct management. Patients and methods. Our study contains patients with inspiratory or inspiratory-exspiratory stridor diagnosed at the ORL Deparment in Children‘s hospital aged from 0 to 19 years of age. All children underwent laryngofibroscopy. Patients with stridor of nonlaryngeal causes, children with acquired diseases of the larynx – laryngitis, laryngeal spasms muscle trauma and foreign body larynx, were all excluded from the study. Results. 539 children patients were involved in our study. The most common cause of stridor was laryngomalacia (81%). The second most common diagnosis was subglottic stenosis in 4% cases, while vocal cord paralysis was diagnosed in 2% of the patients. Laryngofibroscopy revealed a correct diagnosis only in 44% of examined patients. 54% of them needed for definitive diagnosis other diagnostic methods (laryngeal ultrasonography, CT of larynx and chest or laryngotracheoscopy under general anesthesia). Conclusion. Diagnosis of stridor in children is complex and demanding. Various methods of diagnostics are used, while dominant position takes primarily laryngofibroscopy. In unclear cases is this examination accompanied by laryngeal sonography, laryngotracheoscopy in general anesthesia or CT of neck and chest.

Keywords: stridor, laryngeal ultrasonography, laryngofibroscopy, laryngotracheobronchoscopy, CT of larynx and chest