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Stridor - history
Time of Onset
Congenital / acquired
Mode of Onset
Sudden foreign body, oedema Gradual & progressive laryngomalacia, subglottic
Stridor - history
Relation to feeding
Aspiration laryngeal paralysis, esophageal atresia,
Snoring or snorting sound nasal or nasopharynx Gurgling sound & muffled voice - pharynx Hoarse cry or voice - Larynx Expiratory wheeze branchial obstruction
Associated fever
Stridor - Investigation
RADIOGRAPHY X-ray of chest and soft tissue neck
Anteroposteral and lateral view
Fluroscopy
To see chest movement
Tomography of chest
For mediastinal mass
aberrant vessels
Stridor - Investigation
RADIOGRAPHY Angiography
In case of suspected aberrent vessels
Xeroradiography
To show soft tissue lesion obsolete
CT scan/ MRI
Stridor - Investigation
DIRECT LARYNGOSCOPY WITHOUT ANAESTHESIA Can be done in infants and small children Rescuscitative measure and tracheostomy tray should be made available Gives opportunity to see if intubation will be possible or tracheostomy will be required for further examination
Stridor - Investigation
GA Bronchoscopy, Laryngoscopy, Esophagoscopy Bronchoscopy is done after slow induction
Obstruction in air passage subglottis to bronchi Removal of obstruction Obtain aspirate or biopsy
is possible Child intubated detailed exam. Of larynx and esophagus Exclude laryngeal paralysis after anaesthesia has worn out, tube removed
Hoarseness- Investigation
Done as per dictates of the causes suspected Acute
Complete blood count Sedimentation Rate Nose and throat culture Sputum culture
Hoarseness- Investigation
Chronic
Laryngoscopic examination Chest X-ray-if vocal cord paralysis is found CT scan of the mediastinum-if vocal cord paralysis is
found C-1 esterase inhibitor level- to rule out angioneurotic edema CT scan / MRI if neurological abnormalities present
Others
Speech assessment, phonetogram, stroboscopy Direct laryngoscopy and microlaryngoscopy help in
detailed examination Bronchoscopy and esophagoscopy paralytic lesion of cord to exclude malignancy
Hoarseness- Investigation
Phonetogram
teachers, singing teachers and singers find this display to be useful in identifying the limits of vocal function.
Hoarseness- Investigation
Phonetogram
Hoarseness- Investigation
Stroboscopy
Stroboscopy is direct examination of the vocal cords
Laryngomalacia
Bronchoscopy
Omega shaped
epiglottis
Cleft larynx
U-shaped indentation of
Laryngeal papillomatosis
Bunches of wart like
Laryngeal tumors
Laryngocele
MRI
CT scan
CT scan
rigid laryngoscope
Foreign body
Foreign body
Laryngitis
Initially supraglottic edema in arytenoids Then aryepiglottic folds and the false cord Interestingly..
Laryngotracheobronchitis
inflammotory edema Mucosa of the trachea and bronchi also congested & covered with viscous secretion which later on dry up and form crust.
Vocal nodule
Direct laryngoscopy:
Usu bilateral Small nodules Greyish white
2 3rd
VOCAL POLYPS
Soft, smooth,
Bilateral