Alyssa Brzenski MD

ENT PATHOLOGY

CaseA 34 week old premature baby boy was born vaginally to a young mother with chorioamnioitis. At birth the baby was tachypneic and required intubation. Blood cultures were performed and came back positive, so the NICU started the baby on IV Penicillin and Gentamycin for 14 days. He was given surfactant x 3 doses and remained intubated for 7 days. Upon finishing his antibiotic regime, he was allowed to go home with his mother. 2 - 3 weeks later, the mother appears at the pediatricians office with the baby and complains that “the baby turns blue, he’s noisy when he breathes and she has difficulty feeding him.”

“Noisy Breathing” Definition

Differential Diagnosis

Evaluation of Stridor

Laryngomalacia- The Facts• Most common laryngeal anomaly and cause of stridor (54-75%)• DEFINITION:• “Flaccid laryngeal tissue and inward curling of supraglottic

structures during inspiration. There is a fluttering inspiratory stridor that worsens with agitation, crying, feeding or supine.”• Begins in 1st weeks of life and peaks at 6-8 months

Normal Pediatric Anatomy

Laryngomalacia

Treatment

Supraglottoplasty

Before and After

CO2 vs YAG Laser

Type Advantage Disadvantage Other

CO2 Laser Precise; Decreased Post-op Edema

Takes longer for bigger areas

Invisible on it’s own, combined with helium-neon laser

Nd:Yag Laser Great Coagulation

Deep penetration/surrounding tissue damage

Able to go through liquids, can be used in fluid filled areas

Additional Management• Dexamethasone• Possible Post-op Intubation• Racemic Epi• PPI• H2 Blocker

Subglottic Stenosis• Aquired Subglottic Stenosis• From prolonged intubation or high pressure on the tracheal

mucosa

• Congenital Subglottic Stenosis• Cricoid diameter less than 3.5mm• Result of malformation of the cricoid cartilage

Vocal Cord Paralysis• Inspiratory or biphasic stridor, weak cry• Causes• Birth trauma• Central (Arnold-Chiari, Brainstem compression) neurologic

diseases• Thoracic disease or procedures (PDA ligation, aortic arch

surgery)

Posterior glottic web

Anterior Laryngeal Webs

Laryngotracheal Cleft

ENT Pathology and associated Co-morbidities

Sources• Messer A. Congenital Disorders of the Larynx. Cummings Otolaryngology. 5th Ed. 2010. 2866-75.• Boudewyns A, Claes J, Van de Heyning P. An approach to stridor in infants and children. Eur J Pediatr 2010: 169; 135-141.• Richter G, Thompson D. The Surgical Management of Laryngomalacia. Otolaryngol Clin N Am 2008: 41: 837-64.