[Congenital laryngeal stridor - an interdisciplinary problem]. 2013

Dominika Adamczuk, and Grażyna Krzemień, and Agnieszka Szmigielska, and Anna Pierzchlewicz, and Maria Roszkowska-Blaim, and Agnieszka Biejat, and Małgorzata Dębska, and Monika Jabłońska-Jesionowska
Katedra i Klinika Pediatrii i Nefrologii, WUM, Warszawa. d.adamczuk@gmail.com

The most common causes of laryngeal stridor are laryngomalacia (60%), vocal cord paralysis (VCP) (10 %) and subglottic laryngeal stenosis. Majority of cases of VCP are idiopathic, less frequently it is the effect of abnormalities in central nervous system (Arnold - Chiari syndrome, hydrocephalus, neonatal hypoxia). Differential diagnosis should also include anomalies of aortic arch and its branches (vascular rings). The authors present two cases of neonatal congenital laryngeal stridor. In the first case the girl presented with VCP of unknown etiology. The perinatal period was normal, ultrasound of central nervous system and neurologic examination revealed no abnormalities. Due to sustained VCP in control laryngeal ultrasound examinations, tracheostomy was performed in the third month of life. In the second case, stridor was caused by laryngomalacia and subglottic laryngeal stenosis of first grade according to Meyer-Cotton scale (larynx lumen diameter <4 mm). The diagnosis was established by laryngotracheobronchoscopy. In both children angiotomography was performed and vascular ring was diagnosed (aberrant right subclavian artery). Vascular anomaly was suspected in barium X-ray. In both cases echocardiographic examination did not visualize the fourth vessel of the aortic arch. Chest X- rays were normal. Both children had no symptoms caused by vascular ring. CONCLUSIONS Diagnosis of congenital laryngeal stridor is an indication for complete evaluation to establish the cause of the airway obstruction. The differential diagnosis should include laryngomalacia, vocal cord paralysis, subglottic laryngeal stenosis, congenital anomalies of large vessels and abnormalities of the central nervous system.

UI MeSH Term Description Entries
D007223 Infant A child between 1 and 23 months of age. Infants
D007231 Infant, Newborn An infant during the first 28 days after birth. Neonate,Newborns,Infants, Newborn,Neonates,Newborn,Newborn Infant,Newborn Infants
D007829 Laryngostenosis Developmental or acquired stricture or narrowing of the LARYNX. Symptoms of respiratory difficulty depend on the degree of laryngeal narrowing. Laryngeal Stenosis,Acquired Laryngeal Stenosis,Acquired Subglottic Stenosis,Congenital Subglottic Stenosis,Acquired Laryngeal Stenoses,Acquired Subglottic Stenoses,Congenital Subglottic Stenoses,Laryngeal Stenoses,Laryngeal Stenoses, Acquired,Laryngeal Stenosis, Acquired,Laryngostenoses,Stenoses, Acquired Laryngeal,Stenoses, Acquired Subglottic,Stenoses, Congenital Subglottic,Stenoses, Laryngeal,Stenosis, Acquired Laryngeal,Stenosis, Acquired Subglottic,Stenosis, Congenital Subglottic,Stenosis, Laryngeal,Subglottic Stenoses, Acquired,Subglottic Stenoses, Congenital,Subglottic Stenosis, Acquired,Subglottic Stenosis, Congenital
D012135 Respiratory Sounds Noises, normal and abnormal, heard on auscultation over any part of the RESPIRATORY TRACT. Breathing Sounds,Crackles,Lung Sounds,Pleural Rub,Rales,Rhonchi,Stridor,Wheezing,Breathing Sound,Crackle,Lung Sound,Pleural Rubs,Rale,Respiratory Sound,Rhonchus,Rub, Pleural,Sound, Breathing,Sound, Lung,Sound, Respiratory,Sounds, Breathing,Sounds, Lung,Stridors,Wheezings
D005260 Female Females
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D014826 Vocal Cord Paralysis Congenital or acquired paralysis of one or both VOCAL CORDS. This condition is caused by defects in the CENTRAL NERVOUS SYSTEM, the VAGUS NERVE and branches of LARYNGEAL NERVES. Common symptoms are VOICE DISORDERS including HOARSENESS or APHONIA. Laryngeal Nerve Palsy, Recurrent,Laryngeal Paralysis,Acquired Vocal Cord Palsy,Bilateral Vocal Cord Paresis,Congenital Vocal Cord Palsy,Paralysis, Unilateral, Vocal Cord,Paralysis, Vocal Cord, Unilateral,Partial Paralysis (Paresis) Vocal Cords,Recurrent Laryngeal Nerve Palsy,Total Vocal Cord Paralysis,Unilateral Paralysis, Vocal Cord,Unilateral Vocal Cord Paralysis,Unilateral Vocal Cord Paresis,Vocal Cord Palsy,Vocal Cord Palsy, Congenital,Vocal Cord Paralysis, Unilateral,Vocal Cord Paresis,Vocal Fold Palsy,Laryngeal Paralyses,Palsies, Vocal Cord,Palsies, Vocal Fold,Palsy, Vocal Cord,Palsy, Vocal Fold,Paralyses, Laryngeal,Paralyses, Vocal Cord,Paralysis, Laryngeal,Paralysis, Vocal Cord,Pareses, Vocal Cord,Paresis, Vocal Cord,Vocal Cord Palsies,Vocal Cord Paralyses,Vocal Cord Pareses,Vocal Fold Palsies
D055092 Laryngomalacia A congenital or acquired condition of underdeveloped or degeneration of CARTILAGE in the LARYNX. This results in a floppy laryngeal wall making patency difficult to maintain. Chondromalacia of Larynx,Laryngomalacias,Larynx Chondromalacia,Larynx Chondromalacias

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