P020: STRIDOR: AN UNUSUAL PERIOPERATIVE DIAGNOSIS
Alexander Hernandez, OMSIII1; Carli David, OMSIII1; Jason Trahan, MD2; George Semien, MD, MPH, MSc2; 1Edward Via College of Osteopathic Medicine; 2Opelousas General Health System
Introduction: Stridor is defined as a noisy and/or high-pitched sound produced typically during the inspiratory phase of the breathing cycle; it has also been described as “harsh” in nature2. Most commonly stridor is caused by a blockage or narrowing in the upper airway resulting from congenital defects to acquired conditions or infections1. When stridor is congenital, presentation is typically at birth. A thorough history is one of the most important components in deducing what is causing the stridor as it assists in discerning between its presence since birth or later acquisition. Both laryngomalacia and laryngeal webs should be primary suspects in the presence of stridor.
We report the case of an 18-month-old female patient who presented to the otolaryngologist with a primary complaint of stridor. Initial evaluation pointed to a diagnosis of congenital laryngomalacia and was subsequently diagnosed as having a congenital laryngeal web; laryngeal webs, although rare, should form part of any stridor-related differential.
Case: A previously healthy 18-month-old female patient presented to the otolaryngologist with complaints of hoarseness, low-pitch voice, and difficulty speaking. In their history the patient originally presented at 15-months for an initial complaint of dysphonia, difficulty speaking with a low-raspy voice, and throat pain. This initial visit included flexible laryngoscopy through which a flexible laryngoscope was passed through the nostril; vocal cord mobility, piriforms, supraglottis, and nasopharynx all appeared normal, no mucosal lesions or other concerning findings were visualized. The patient was subsequently diagnosed with laryngomalacia. Treatment efforts included initiation of cefdinir 5mL, orally, daily for 7 days in case of infection and a rapid strep test for the throat pain was ordered - which came back negative. At follow-up hoarseness became the primary complaint in addition to dysphonia and a low-pitch voice. Investigations continued as there was no improvement since the first visit and there was a worsening of symptoms with the addition of hoarseness.
Otolaryngology called for a direct surgical laryngoscopy with telescope utilization in the community hospital setting. The patient was diagnosed with congenital laryngeal web after surgical laryngoscopy due to remarkable findings of omega epiglottis with apparent laryngomalacia and an anterior laryngeal web. Examination with the laryngoscope revealed that the anterior laryngeal web was obstructing the anterior one-third of the glottis. The patient was referred for surgical intervention to correct the congenital defect.
Discussion: Our report demonstrates the purpose of widening the differential diagnosis when a patient presents with stridor. Laryngomalacia and laryngeal webs should be considered when a young patient presents with stridor and hoarseness3. While laryngeal webs are generally diagnosed within the first few months of life, it should still be investigated in an older child with recurrent stridor.
1. default - Stanford Children’s Health. www.stanfordchildrens.org. https://www.stanfordchildrens.org/en/topic/default?id=stridor-90-P02066
2. Derinöz O, Sismanlar T. An unusual cause of stridor: congenital laryngeal web. Turkish Archives of Pediatrics/Türk Pediatri Arsivi. 2018;53(3):185-188. doi:10.5152/TurkPediatriArs.2017.3922
3. Wang Y. Case Report: A Rare Cause of Stridor and Hoarseness in Infants—Congenital Laryngeal Web. Frontiers in Pediatrics. 2022;10:875137. doi:10.3389/fped.2022.875137