Congenital stridor – pathological noisy (whistling or hissing) the breath caused by congenital anomaly of a structure of a throat or trachea. The congenital stridor is shown by the loud complicated breath which increases during the crying, cough. Diagnostics of a congenital stridor is carried out by the pediatrician, the otolaryngologist and the pulmonologist taking into account data of the anamnesis, a laringoskopiya, trakheobronkhoskopiya, ezofagoskopiya. Treatment of the congenital stridor caused by the functional reasons is not required: in process of growth of cartilages of a throat (by 2-3 years) stridorozny breath disappears. If pathology is connected with the organic reasons, surgical intervention can be required.
The congenital stridor is a disease of children of early age which experts should face in the field of pediatrics, otolaryngology and pulmonology. The congenital stridor is usually shown since the birth, debuts on the first month of life of the child or less often a bit later. Pathologically noisy breath connected with overcoming resistance which is encountered on the way of air masses when passing through the narrowed site of a throat is a characteristic sign of a stridor. The congenital stridor is not an independent nosological form, and indicates the respiratory obstruction caused by various pathological conditions of a throat and trachea.
Reasons of a congenital stridor
From 60 to 70% of cases of a congenital stridor at children are caused by anomalies of development of a throat and the top airways. Most often stridorozny breath is caused by congenital weakness of an external ring of a throat (laringomalyation). In this case during a breath a nadgortannik and cherpalonadgortanny folds prolabirut in a throat cavity that is followed by its obstruction and a stridorozny sound on a breath. Laringomalyation is often observed at the children born from the premature birth having a hypotrophy, rickets, a spazmofiliya. In some cases congenital weakness of a throat can be combined with other defects of airways – for example, a trakheomalyation and a trakheobronkhomalyation.
These violations connect with a local form of the muscular hypotonia caused by an arrest of development of the neuromuscular device. At children with a congenital stridor neuromuscular insufficiency can be also shown by a gastroezofagealny reflux, an akhalaziy sebesten, a dream, ptozy a century.
Much less often among the reasons of a congenital stridor benign tumors of a throat (a gemangioma, a limfangioma, throats), malignant new growths, an atresia Joán, paresis and paralyzes of voice folds, a cicatricial laringotrakhealny stenosis, a congenital craw, etc. come to light. If the congenital stridor arises during feeding, it is necessary to think of an esophageal trakhealnom fistula or a crevice of a throat.
The congenital stridor can meet as separately, and to enter into structure of genetic syndromes (Down, Marfana, Pierre-Robena, etc.). Quite often congenital stridor is accompanied by other congenital pathology - a gipertenzionno-gidrotsefalny or convulsive syndrome, heart diseases (an open oval window, an additional chord of a ventricle), pulmonary hypertensia, etc.
The acquired stridor can be a symptom of tumors of a trachea and bronchial tubes, obturation of a trakheobronkhialny tree foreign matters, bronchial asthma, allergic hypostasis of airways, infections (an epiglottit, zaglotochny abscess, a croup), the subcopular stenosis caused by a long intubation, throat cancer or a gullet, a tireoidit.
Classification of a congenital stridor
By extent of violation of breath the congenital stridor is classified as follows:
- The I degree (compensated) - a congenital stridor does not demand treatment;
- The II degree (boundary compensated) - a congenital stridor demands dynamic observation and, perhaps, treatments;
- The III degree (dekompensirovanny) – the congenital stridor demanding treatment;
- The VI degree – a congenital stridor, incompatible with life, demanding immediate resuscitation actions and surgical treatment.
Distinguish three types of a congenital stridor: inspiratory, expiratory and two-phase. The inspiratory stridor develops on a breath; at the same time the stridorozny noise of low sounding caused by localization of defeat is formed is higher than voice folds (in the field of a gortanoglotka or the top department of a throat). At a two-phase stridor obstruction of airways at the level of voice folds takes place; at the same time there is a noisy breath of high sounding. The congenital stridor of expiratory type developing on an exhalation is caused by obstruction below voice folds and is characterized by the average height of a stridorozny sound.
Symptoms of a congenital stridor
The congenital stridor is shown already soon after the birth of the child and amplifies in the first weeks of life. At the same time the characteristic loud sounding heard at distance arising at break of an air stream through the narrowed throat pays attention. Noise can be whistling, ringing or hissing, deaf; to remind a cooing of pigeons, purring of a cat, cock shout or a cackle of chicken. During sleep, stays in the warm room, at rest intensity of noise decreases; when sucking, crying, cough – opposite, increases.
In most cases the congenital stridor proceeds in the easy, compensated degree, allowing the child to raise and develop normally. At the compensated congenital stridor the physical condition of the child, as a rule, does not suffer, the act of sucking is not violated, the voice is kept. However in certain cases, stridorozny breath can be combined with the phenomena of a dysphonia and a dysphagy.
When developing the SARS which are followed by catarrhal changes of the top airways there is a bad attack of a stridor. It is shown by short wind, a laryngospasm, cyanosis of integuments, retraction of intercostal intervals of a thorax, a jugular pole and epigastralny area at a breath. At a severe form of a congenital stridor asphyxia and sharp respiratory insufficiency can develop.
Diagnostics of a congenital stridor
Survey of the child by the pediatrician, otolaryngologist, pulmonologist, neurologist, gastroenterologist is necessary for clarification of the reasons of a congenital stridor. At survey the general condition of the child, ChD and ChSS, coloring of integuments, participation of auxiliary muscles in the act of breath, retraction of compliant sites of a thorax at breath is estimated etc.
The mikrolaringoskopiya is surely carried out; if necessary the X-ray analysis of a throat and soft tissues of a neck, ultrasonography of a throat, KT and MPT, a thorax X-ray analysis, a trakheobronkhoskopiya, a bronchography is carried out. At a combination of symptoms of a congenital stridor to a dysphagy inspection is supplemented with gullet roentgenoscopy, an ezofagogastroduodenoskopiya, ultrasonography of an abdominal cavity. At a dysphonia and an aphonia carrying out a neyrosonografiya, brain EEG, KT is expedient. At suspicion of a congenital craw consultation of the endocrinologist with performing ultrasonography of a thyroid gland, determination of the TTG level, T3, T4 is necessary.
Differential diagnostics of a congenital stridor should be carried out with laryngitis, a true and false croup, zaglotochny abscess, foreign matters of a throat, trachea and bronchial tubes, bronkhoadenity at tuberculosis, limfogranulematozy.
Treatment of a congenital stridor
In most cases the phenomenon compensated and the boundary compensated congenital stridor, decrease to the 6th month of life of the child and disappear completely by 2-3 years. Regular observation of the otolaryngologist is recommended; special treatment at the same time usually it is not carried out.
In some cases at a laringomalyation resort to drawing by the laser of cuts on a nadgortannik, to a section of cherpalonadgortanny folds or removal of a part of cherpalovidny cartilages. At the bad attacks of a congenital stridor which developed against the background of a SARS immediate hospitalization is required. In a hospital hormonal medicines, inhalations, bronchial spasmolytics can be appointed. At development of critical condition tracheotomy or an intubation with IVL is shown.
At the congenital stridor caused by tumoral processes endoscopic removal of good-quality new growths of a throat is necessary. At the stridor caused congenital by a hypothyroidism therapy is carried out gormonozamestitelny.
The forecast and prevention of complications at a congenital stridor
In process of growth of the child, cartilages of a throat become firmer, the throat gleam - is wider therefore the phenomena of a congenital stridor can spontaneously regress by 2-3 years. During this period it is necessary to care for prevention of catarrhal diseases, good nutrition, holding the tempering actions, creation of a favorable psychological situation. In the presence of the organic reasons of a congenital stridor and the accompanying pathology their timely elimination is necessary.
In case of accession of a respiratory infection, a decompensation of a congenital stridor and development of respiratory insufficiency, the forecast can cause fears.