Congenital Stridor Workup
- Author: Timothy D Murphy, MD; Chief Editor: Michael R Bye, MD more...
See the list below:
- Chest radiography may be helpful in diagnosing a vascular ring if a right-sided aortic arch is observed in patients with congenital stridor.
- Standard neck radiography is rarely helpful unless a large mass is responsible for the obstruction. High-kilovoltage radiography can highlight the tracheal structures better and may provide more information. These radiographs use a higher radiation dose.
- CT scanning of the neck and chest may be helpful, especially if the radiology facility can perform airway reconstruction imaging. However, the need for cooperation in generating such images limits the use of CT imaging in infants and young children with congenital stridor.
- Barium esophagraphy can be helpful in diagnosing vascular rings if an indentation in the esophagus is present. The pattern of indentation may also be helpful in indicating what type of vascular anomaly may be present. However, the lesion of anomalous innominate artery does not yield abnormal findings on esophagraphy.
See the list below:
- A multichannel sleep study that measures airflow, chest wall excursion, oxygen saturation, and heart rate can provide useful information about the severity of obstruction.
- An ABG study can reveal the presence of carbon dioxide retention or chronic hypoxemia.
- In cases of suspected gastroesophageal reflux (GER), 24-hour mid esophageal pH monitoring may be helpful in establishing the diagnosis.
See the list below:
- Fiberoptic laryngoscopy and bronchoscopy, valuable diagnostic tools for the evaluation of congenital stridor, offer several important advantages over radiographic imaging, including the following:
- Lesions can be directly visualized. Evidence of inflammation or bleeding can be observed. Characteristics of the lesion, such as vascularity, can be determined.
- Biopsies and bronchoalveolar lavage samples can be taken if necessary.
- The examination is conducted while the patient is actively breathing, allowing assessment of dynamic events.
- Fiberoptic direct laryngoscopy can be performed in the office. However, in the pediatric population this procedure can be performed most safely while the patient is sedated. Bronchoscopy in a child requires intravenous conscious sedation or general anesthesia.
Belmont JR, Grundfast K. Congenital laryngeal stridor (laryngomalacia): etiologic factors and associated disorders. Ann Otol Rhinol Laryngol. 1984 Sep-Oct. 93(5 Pt 1):430-7. [Medline].
Jephson CG, Mills NA, Pitt MC, Beeson D, Aloysius A, Muntoni F, et al. Congenital stridor with feeding difficulty as a presenting symptom of Dok7 congenital myasthenic syndrome. Int J Pediatr Otorhinolaryngol. 2010 Sep. 74(9):991-4. [Medline].
Lee ML, Chen M, Tsao LY, Chiu HY, Chiu IS, Yang AD, et al. Congenital stridor and wheezing as harbingers of the del22q11.2 syndrome presenting cardiovascular malformations of right aortic arch, aberrant left subclavian artery, Kommerell's diverticulum, and left ligamentum arteriosum. Cardiovasc Pathol. 2011 Mar-Apr. 20(2):124-9. [Medline].
Klein A, Pitt MC, McHugh JC, Niks EH, Sewry CA, Phadke R, et al. DOK7 congenital myasthenic syndrome in childhood: early diagnostic clues in 23 children. Neuromuscul Disord. 2013 Nov. 23(11):883-91. [Medline].
Wright CT, Goudy SL. Congenital laryngomalacia: symptom duration and need for surgical intervention. Ann Otol Rhinol Laryngol. 2012 Jan. 121(1):57-60. [Medline].
Stritzke AI, Dunham CP, Smyth JA, Steinbok P. Congenital stridor in the context of Chiari malformation type II: the etiological role of vernix caseosa granulomatous meningitis. J Neurosurg Pediatr. 2011 Oct. 8(4):372-6. [Medline].
Aksoy EA, Elsürer C, Serin GM, Unal OF. Evaluation of pediatric subglottic cysts. Int J Pediatr Otorhinolaryngol. 2012 Feb. 76(2):240-3. [Medline].
Berdon WE, Baker DH. Vascular anomalies and the infant lung: rings, slings, and other things. Semin Roentgenol. 1972 Jan. 7(1):39-64. [Medline].
Zalzal GH, Anon JB, Cotton RT. Epiglottoplasty for the treatment of laryngomalacia. Ann Otol Rhinol Laryngol. 1987 Jan-Feb. 96(1 Pt 1):72-6. [Medline].
Cotton RT. Pediatric laryngotracheal stenosis. J Pediatr Surg. 1984 Dec. 19(6):699-704. [Medline].
Cotton RT, Evans JN. Laryngotracheal reconstruction in children. Five-year follow-up. Ann Otol Rhinol Laryngol. 1981 Sep-Oct. 90(5 Pt 1):516-20. [Medline].
Cotton RT, Schreiber JT. Management of laryngotracheoesophageal cleft. Ann Otol Rhinol Laryngol. 1981 Jul-Aug. 90(4 Pt 1):401-5. [Medline].
McSwiney PF, Cavanagh NP, Languth P. Outcome in congenital stridor (laryngomalacia). Arch Dis Child. 1977 Mar. 52(3):215-8. [Medline].
Nielson DW, Heldt GP, Tooley WH. Stridor and gastroesophageal reflux in infants. Pediatrics. 1990 Jun. 85(6):1034-9. [Medline].
Orenstein SR, Kocoshis SA, Orenstein DM, Proujansky R. Stridor and gastroesophageal reflux: diagnostic use of intraluminal esophageal acid perfusion (Bernstein test). Pediatr Pulmonol. 1987 Nov-Dec. 3(6):420-4. [Medline].
Parnell FW, Brandenburg JH. Vocal cord paralysis. A review of 100 cases. Laryngoscope. 1970 Jul. 80(7):1036-45. [Medline].
Richardson MA, Cotton RT. Anatomic abnormalities of the pediatric airway. Ear Nose Throat J. 1985 Jan. 64(1):47-60. [Medline].
Stanger P, Lucas RV Jr, Edwards JE. Anatomic factors causing respiratory distress in acyanotic congenital cardiac disease. Special reference to bronchial obstruction. Pediatrics. 1969 May. 43(5):760-9. [Medline].
Weiss LN. The diagnosis of wheezing in children. Am Fam Physician. 2008 Apr 15. 77(8):1109-14. [Medline].