title: Recurrent stridor in a 9-year-old child after a choking and aspiration event.
abstract: This is a case report of a 9-year-old boy with new onset stridor 5 days after a choking event. Symptoms would last 5-45 minutes. His stridor was unresponsive to nebulized epinephrine but improved when he relaxed. Otlaryngology examination noted laryngeal irritation that was suggestive of gastroesophageal reflux (GER). Episodic stridor continued, despite treatment for GER, prompting hospitalization. On admission, barium swallow indicated hyperinflation of the left lung and bronchoscopy confirmed the aspiration of food. Within 12 hours of bronchoscopy, his stridor recurred. The recurrence of stridor after bronchoscopy resulted in further evaluation of his upper airway disorder. The true diagnosis was revealed during methacholine challenge. This case illustrates a unique presentation of a common upper respiratory disorder, the need for a high index of suspicion to make the diagnosis, and the importance of the multispecialty approach needed to treat patients with this disorder.
authors.affiliation: Department of Pediatrics, Le Bonheur Children's Hospital, University of Tennessee Health Sciences Center, Memphis, Tennessee 38103, USA.
authors.forename: Thomas G
authors.initials: TG
authors.lastname: Sternberg
authors.forename: Jerome W
authors.initials: JW
authors.lastname: Thompson
authors.forename: Robert A
authors.initials: RA
authors.lastname: Schoumacher
authors.forename: Dukee B
authors.initials: DB
authors.lastname: Lew
mesh_terms: D000402:Airway Obstruction / Q000150:complications / Q000175:diagnosis* / Q000503:physiopathology / Q000628:therapy; D001985:Bronchial Provocation Tests; D001999:Bronchoscopy; D002648:Child; D003937:Diagnosis, Differential; D004358:Drug Therapy; D005764:Gastroesophageal Reflux / Q000150:complications / Q000175:diagnosis* / Q000503:physiopathology / Q000628:therapy; D006801:Humans; D007828:Laryngoscopy; D008297:Male; D009771:Obsessive-Compulsive Disorder / Q000150:complications / Q000175:diagnosis* / Q000503:physiopathology / Q000628:therapy; D010349:Patient Compliance; D012008:Recurrence; D012064:Relaxation Therapy; D053120:Respiratory Aspiration / Q000150:complications / Q000175:diagnosis* / Q000503:physiopathology / Q000628:therapy; D012135:Respiratory Sounds / Q000209:etiology*; D013147:Spirometry; D014832:Voice Disorders / Q000150:complications / Q000175:diagnosis* / Q000503:physiopathology / Q000628:therapy