WordNet

a whistling sound when breathing (usually heard on inspiration); indicates obstruction of the trachea or larynx
present at birth but not necessarily hereditary; acquired during fetal development (同)inborn, innate

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(病気・身体的欠陥など)生まれつきの,先天的な

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出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2015/07/19 10:14:35」(JST)

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	Stridor Inspiratory and expiratory stridor in a 13-month child with croup.
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Stridor (Latin for "creaking or grating noise") is a high-pitched breath sound resulting from turbulent air flow in the larynx or lower in the bronchial tree. It should not to be confused with stertor which is a noise originating in the pharynx. Stridor is a physical sign which is caused by a narrowed or obstructed airway. It can be inspiratory, expiratory or biphasic, although it is usually heard during inspiration. Inspiratory stridor often occurs in children with croup. It may be indicative of serious airway obstruction from severe conditions such as epiglottitis, a foreign body lodged in the airway, or a laryngeal tumor. Stridor should always command attention to establish its cause. Visualization of the airway by medical experts equipped to control the airway may be needed.

Causes

Stridor may occur as a result of:

Foreign bodies (e.g., aspirated foreign body, aspirated food bolus);
Tumor (e.g., laryngeal papillomatosis, squamous cell carcinoma of larynx, trachea or esophagus);
ALL (T-cell ALL can present with mediastinal mass that compresses the trachea and causes inspiratory stridor);
Infections (e.g., epiglottitis, retropharyngeal abscess, croup);
Subglottic stenosis (e.g., following prolonged intubation or congenital);
Airway edema (e.g., following instrumentation of the airway, tracheal intubation, drug side effect, allergic reaction);
Subglottic hemangioma (rare);
Vascular rings compressing the trachea;
Many thyroiditis such as Riedel's thyroiditis;
Vocal cord palsy;
Tracheomalacia or Tracheobronchomalacia (e.g., collapsed trachea).
Congenital anomalies of the airway are present in 87% of all cases of stridor in infants and children.^[1]
Vasculitis.

Diagnosis

Stridor is usually diagnosed on the basis of history and physical examination, with a view to revealing the underlying problem or condition.

Chest and neck x-rays, bronchoscopy, CT-scans, and/or MRIs may reveal structural pathology.

Flexible fiberoptic bronchoscopy can also be very helpful, especially in assessing vocal cord function or in looking for signs of compression or infection.

Treatments

The first issue of clinical concern in the setting of stridor is whether or not tracheal intubation or tracheostomy is immediately necessary. A reduction in oxygen saturation is considered a late sign of airway obstruction, particularly in a child with healthy lungs and normal gas exchange. Some patients will need immediate tracheal intubation. If intubation can be delayed for a period, a number of other potential options can be considered, depending on the severity of the situation and other clinical details. These include:

Expectant management with full monitoring, oxygen by face mask, and positioning the head on the bed for optimum conditions (e.g., 45 - 90 degrees).
Use of nebulized racemic adrenaline epinephrine (0.5 to 0.75 ml of 2.25% racemic epinephrine added to 2.5 to 3 ml of normal saline) in cases where airway edema may be the cause of the stridor. (Nebulized Codeine in a dose not exceeding 3 mg/kg may also be used, but not together with racemic adrenaline [because of the risk of ventricular arrhythmias].)
Use of dexamethasone (Decadron) 4–8 mg IV q 8 - 12 h in cases where airway edema may be the cause of the stridor; note that some time (in the range of hours) may be needed for dexamethasone to work fully.
Use of inhaled Heliox (70% helium, 30% oxygen); the effect is almost instantaneous. Helium, being a less dense gas than nitrogen, reduces turbulent flow through the airways. Always ensure an open airway.

In obese patients elevation of the panniculus has shown to relieve symptoms by 80%.

References

^ Holinger LD (1980). "Etiology of stridor in the neonate, infant and child". Ann. Otol. Rhinol. Laryngol. 89 (5 Pt 1): 397–400. PMID 7436240.

External links

Audio Breath Sounds - Multiple case studies with audio files of lung sounds.

Stridor at eMedicine
Congenital stridor at eMedicine
MedlinePlus Encyclopedia Breathing sounds - abnormal (stridor)
DDB 27190

Stridor sounds at R.A.L.E. Lung Sounds

UpToDate Contents

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1. 小児における吸気時喘鳴の評価 assessment of stridor in children
2. 喉頭の先天異常 congenital anomalies of the larynx
3. 下顎、口、口腔、および咽頭の先天異常 congenital anomalies of the jaw mouth oral cavity and pharynx
4. 小児における喘息以外の喘鳴疾患 wheezing illnesses other than asthma in children
5. 成人における気管軟化症および気管気管支軟化症 tracheomalacia and tracheobronchomalacia in adults

English Journal

Prenatal Echocardiographic Diagnosis of Double Aortic Arch.

Hunter L1, Callaghan N, Patel K, Rinaldi L, Bellsham-Revell H, Sharland G.
Ultrasound in obstetrics & gynecology : the official journal of the International Society of Ultrasound in Obstetrics and Gynecology.Ultrasound Obstet Gynecol.2014 May 10. doi: 10.1002/uog.13408. [Epub ahead of print]
A double aortic arch is a congenital anomaly, associated with the formation of a vascular ring which can cause varying degrees of airway compression. This can be subclinical or clinical in the form of acute stridor, severe respiratory compromise, or symptoms of chronic airway compression. An accurat
PMID 24817195

Flexible Carbon Dioxide Laser-Assisted Endoscopic Marsupialization and Ablation of a Laryngeal Saccular Cyst in a Neonate.

Massoth LJ1, Digoy GP.
The Annals of otology, rhinology, and laryngology.Ann Otol Rhinol Laryngol.2014 Mar 18. [Epub ahead of print]
OBJECTIVE: To report the occurrence of a neonate with a lateral saccular cyst that was successfully managed by flexible, carbon dioxide laser-assisted endoscopic marsupialization and ablation.CASE SUMMARY: A full-term, 14-day-old girl presented to the clinic for progressively worsening stridor since
PMID 24646753