eMedicine Specialties > Pediatrics: General Medicine > Pulmonology

Congenital Stridor: Treatment & Medication

Author: Timothy D Murphy, MD, Assistant Professor, Department of Pediatrics, Division of Pulmonology, University of Pittsburgh; Consulting Staff, Division of Pulmonology, Children's Hospital of Pittsburgh
Coauthor(s): Clement L Ren, MD,, Chief, Division of Pediatric Pulmonology, Department of Pediatrics, Associate Professor, Golisano Children's Hospital at Strong, University of Rochester, New York
Contributor Information and Disclosures

Updated: Feb 17, 2009

Treatment

Medical Care

Medical care is primarily supportive because many causes of congenital stridor resolve spontaneously over time. For those that do not, such as vascular rings, surgical treatment is usually definitive. However, in some patients, tracheomalacia persists for some time after such a repair. In severe cases of congenital stridor, nonsurgical therapy may have a role prior to definitive surgical correction.

  • Supplemental oxygen can be used to treat hypoxemia.
  • Noninvasive positive pressure mechanical ventilation can maintain a patent airway in cases of airway collapse, such as tracheomalacia.
  • If an airway cannot be maintained by noninvasive positive pressure mechanical ventilation, intubation with mechanical ventilation may be indicated.

Surgical Care

Surgical management depends on the specific lesion that causes stridor.

  • In general, indications for surgical correction include the following:
    • Inability to maintain a patent airway
    • Feeding difficulties or failure to thrive
    • Inability to maintain adequate oxygenation
  • Some of the surgical procedures used to treat congenital stridor include the following:
    • Epiglottoplasty for laryngomalacia3
    • Tracheostomy for severe subglottic stenosis or tracheomalacia
    • Division of a vascular ring
    • Tracheoplasty for complete tracheal rings

More on Congenital Stridor

Overview: Congenital Stridor
Differential Diagnoses & Workup: Congenital Stridor
Treatment & Medication: Congenital Stridor
Follow-up: Congenital Stridor
References
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References

  1. Belmont JR, Grundfast K. Congenital laryngeal stridor (laryngomalacia): etiologic factors and associated disorders. Ann Otol Rhinol Laryngol. Sep-Oct 1984;93(5 Pt 1):430-7. [Medline].

  2. Berdon WE, Baker DH. Vascular anomalies and the infant lung: rings, slings, and other things. Semin Roentgenol. Jan 1972;7(1):39-64. [Medline].

  3. Zalzal GH, Anon JB, Cotton RT. Epiglottoplasty for the treatment of laryngomalacia. Ann Otol Rhinol Laryngol. Jan-Feb 1987;96(1 Pt 1):72-6. [Medline].

  4. Cotton RT. Pediatric laryngotracheal stenosis. J Pediatr Surg. Dec 1984;19(6):699-704. [Medline].

  5. Cotton RT, Evans JN. Laryngotracheal reconstruction in children. Five-year follow-up. Ann Otol Rhinol Laryngol. Sep-Oct 1981;90(5 Pt 1):516-20. [Medline].

  6. Cotton RT, Schreiber JT. Management of laryngotracheoesophageal cleft. Ann Otol Rhinol Laryngol. Jul-Aug 1981;90(4 Pt 1):401-5. [Medline].

  7. McSwiney PF, Cavanagh NP, Languth P. Outcome in congenital stridor (laryngomalacia). Arch Dis Child. Mar 1977;52(3):215-8. [Medline].

  8. Nielson DW, Heldt GP, Tooley WH. Stridor and gastroesophageal reflux in infants. Pediatrics. Jun 1990;85(6):1034-9. [Medline].

  9. Orenstein SR, Kocoshis SA, Orenstein DM, Proujansky R. Stridor and gastroesophageal reflux: diagnostic use of intraluminal esophageal acid perfusion (Bernstein test). Pediatr Pulmonol. Nov-Dec 1987;3(6):420-4. [Medline].

  10. Parnell FW, Brandenburg JH. Vocal cord paralysis. A review of 100 cases. Laryngoscope. Jul 1970;80(7):1036-45. [Medline].

  11. Richardson MA, Cotton RT. Anatomic abnormalities of the pediatric airway. Ear Nose Throat J. Jan 1985;64(1):47-60. [Medline].

  12. Stanger P, Lucas RV Jr, Edwards JE. Anatomic factors causing respiratory distress in acyanotic congenital cardiac disease. Special reference to bronchial obstruction. Pediatrics. May 1969;43(5):760-9. [Medline].

  13. Weiss LN. The diagnosis of wheezing in children. Am Fam Physician. Apr 15 2008;77(8):1109-14. [Medline].

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Further Reading

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Keywords

congenital stridor, congenital croup, chronic congestion, obstruction of airway, noisy breathing, obstruction of trachea, trachea obstruction, micrognathia, bilateral vocal cord paralysis, subglottic hemangioma, airway obstruction, respiratory distress, failure to thrive, increased work of breathing, laryngomalacia, Arnold-Chiari malformation, webs, cysts, papillomata, and laryngotracheoesophageal clefts, subglottic stenosis, double aortic arch, pulmonary artery sling, bronchogenic cyst, tracheomalacia, gastroesophageal reflux, GER, cardio-vocal syndrome, airway foreign body

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Contributor Information and Disclosures

Author

Timothy D Murphy, MD, Assistant Professor, Department of Pediatrics, Division of Pulmonology, University of Pittsburgh; Consulting Staff, Division of Pulmonology, Children's Hospital of Pittsburgh
Disclosure: Nothing to disclose.

Coauthor(s)

Clement L Ren, MD,, Chief, Division of Pediatric Pulmonology, Department of Pediatrics, Associate Professor, Golisano Children's Hospital at Strong, University of Rochester, New York
Clement L Ren, MD, is a member of the following medical societies: American Academy of Allergy Asthma and Immunology, American Academy of Pediatrics, American College of Chest Physicians, and American Thoracic Society
Disclosure: Nothing to disclose.

Medical Editor

Thomas Scanlin, MD, Chief, Division of Pediatric Pulmonary & Cystic Fibrosis, Assistant Professor, Department of Pediatrics, Robert Wood Johnson University Medical Group
Thomas Scanlin, MD is a member of the following medical societies: American Thoracic Society and Society for Pediatric Research
Disclosure: Nothing to disclose.

Pharmacy Editor

Mary L Windle, PharmD, Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy, Pharmacy Editor, eMedicine
Disclosure: Pfizer Inc Stock Investment from financial planner; Avanir Pharma Stock Investment from financial planner ; WebMD Salary and stock Employment and investment from financial planner

Managing Editor

Charles Callahan, DO, Professor, Deputy Chief of Clinical Services, Walter Reed Army Medical Center
Charles Callahan, DO is a member of the following medical societies: American Academy of Pediatrics, American College of Chest Physicians, American College of Osteopathic Pediatricians, American Thoracic Society, Association of Military Surgeons of the US, and Christian Medical & Dental Society
Disclosure: Nothing to disclose.

CME Editor

Mary E Cataletto, MD, Associate Director, Division of Pediatric Pulmonology, Winthrop University Hospital; Professor of Clinical Pediatrics, State University of New York at Stony Brook; Director of Children's Sleep Services, Winthrop University Hospital
Mary E Cataletto, MD is a member of the following medical societies: American Academy of Pediatrics and American College of Chest Physicians
Disclosure: Shering Plough Pharmaceuticals Honoraria Consulting

Chief Editor

Michael R Bye, MD, Professor of Clinical Pediatrics, Division of Pulmonary Medicine, Columbia University College of Physicians and Surgeons; Attending Physician, Pediatric Pulmonary Medicine, Morgan Stanley Children's Hospital of New York Presbyterian, Columbia University Medical Center
Michael R Bye, MD is a member of the following medical societies: American Academy of Pediatrics, American College of Chest Physicians, and American Thoracic Society
Disclosure: Merck Honoraria Speaking and teaching

 
 
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