Overview
Congenital laryngeal stridor refers to noisy breathing, often expiratory, due to anatomical abnormalities or functional disturbances affecting the larynx from birth. It can manifest with varying severity and may have both organic and non-organic etiologies 13.Diagnosis
Clinical Presentation: Loud expiratory stridor, potentially with abrupt onset and nocturnal remission 1.
Diagnostic Tests:
- Videolaryngoscopy: Essential to rule out anatomical obstructions; normal anatomy may still indicate functional causes 1.
- Flexible Fiberoptic Videolaryngoscopy: Useful for identifying paradoxical vocal fold movement 3.
Differential Diagnosis: Consider psychological causes, paradoxical vocal fold movement, and other functional stridor syndromes 13.Management
First-Line Treatments:
- Voice/Speech Therapy: Effective for functional causes like paradoxical vocal fold movement and psychological stridor 13.
Adjunctive Treatments:
- Medical Management: For conditions like red man's syndrome (e.g., supportive care, discontinuation of offending agent) 2.
- Observation: For benign cases with no underlying pathology, monitoring may be sufficient 4.Special Populations
Pediatrics: Psychological causes should be considered in pediatric cases, avoiding unnecessary invasive procedures 1.
Comorbidities: Infants with congenital stridor may have less frequent obstructive sleep apnea compared to controls 4.Key Recommendations
Consider Psychological Causes in Pediatric Stridor: Evaluate for non-organic etiologies, particularly in cases with normal laryngeal anatomy 1 (Evidence: Moderate).
Utilize Videolaryngoscopy for Diagnosis: Essential for differentiating between anatomical and functional causes of stridor 13 (Evidence: Moderate).
Voice Therapy for Functional Stridor: Effective first-line treatment for paradoxical vocal fold movement and psychological stridor 13 (Evidence: Weak).References
1 Cantarella G, Ciabatta AC. A Rare Cause of Extremely Loud Expiratory Stridor in a 11-Year-Old Patient. The Laryngoscope 2021. link
2 Apuya J, Klein EF. Stridor accompanying red man's syndrome following perioperative administration of vancomycin. Journal of clinical anesthesia 2009. link
3 Pinho SM, Tsuji DH, Sennes L, Menezes M. Paradoxical vocal fold movement: a case report. Journal of voice : official journal of the Voice Foundation 1997. link80017-3)
4 Abreu e Silva FA, Williams A, Simpson H. Sleep apnoea in infants with congenital stridor. Archives of disease in childhood 1986. link