Etiology of stridor in infants.
OBJECTIVE
We undertook to identify data that facilitate determination of an accurate diagnosis of the cause of stridor in infants and to develop a framework to conceptualize the problem.


METHODS
We reviewed medical records of patients less than 1 year of age with the presenting symptom of stridor who were initially evaluated in the outpatient setting of a tertiary children's hospital. Infants with obvious congenital syndromes, cerebral palsy, or hypotonia were excluded. All infants underwent history-taking, physical examination, and when symptoms were mild, office flexible laryngoscopy. With moderate or severe stridor, a more complete endoscopic evaluation was undertaken in the operating room.


RESULTS
Of 202 patients, 119 (59%) were boys and 83 (41%) were girls. Their ages ranged from 3 days to 11 months; 175 (87%) were 6 months of age or younger. Congenital anomalies were diagnosed as the cause of stridor in 170 (84%). Congenital laryngeal anomalies caused stridor in 157 (78%); congenital tracheal abnormalities were the cause in 13 (6%). The most common congenital laryngeal anomaly was laryngomalacia (94%). Forty-two (21%) of the 202 patients had at least 1 other anomaly that contributed to airway compromise. Half of all patients had laryngopharyngeal reflux, the most common associated condition. Of patients referred with a presumptive diagnosis by non-otolaryngologists, 28 of 94 (30%) were referred with erroneous presumptive diagnoses for which they were being treated, the most common of which was tracheomalacia.


CONCLUSIONS
A standard, rational approach to the evaluation of stridor in infants facilitates management. A framework for evaluation is presented.
Zoumalan
Richard
R
Division of Pediatric Otolaryngology, The Children's Memorial Hospital, Chicago, IL 60614, USA.
Maddalozzo
John
J
Holinger
Lauren D
LD
D000402:Airway Obstruction / Q000209:etiology; D001980:Bronchi / Q000002:abnormalities; D005260:Female; D005350:Fibroma / Q000150:complications; D005764:Gastroesophageal Reflux / Q000150:complications; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007830:Larynx / Q000002:abnormalities; D008297:Male; D012135:Respiratory Sounds / Q000209:etiology*; D012140:Respiratory Tract Diseases / Q000150:complications; D012189:Retrospective Studies; D014132:Trachea / Q000002:abnormalities