FREQUENTLY RECURRING OR PERSISTENT STRIDOR Stridor, a harsh, medium-pitched, inspiratory sound associated with obstruction of the laryngeal area or the extrathoracic trachea, is often accompanied by a croupy cough and hoarse voice. Stridor is most commonly observed in children with croup; foreign bodies and trauma can also cause acute stridor. A small number of children, however, acquire recurrent stridor or have persistent stridor from the 1st days or weeks of life ( Table 381-5 ). Most congenital anomalies of large airways that produce stridor become symptomatic soon after birth. Increase of stridor when a child is supine suggests laryngomalacia or tracheomalacia. An accompanying history of hoarseness or aphonia suggests involvement of the vocal cords. TABLE 381-5 -- Causes of Recurrent or Persistent Stridor in Children RECURRENT Allergic (spasmodic) croup Respiratory infections in a child with otherwise asymptomatic anatomic narrowing of the large airways Laryngomalacia PERSISTENT Laryngeal obstruction Laryngomalacia Papillomas, other tumors Cysts and laryngoceles Laryngeal webs Bilateral abductor paralysis of the cords Foreign body Tracheobronchial disease Tracheomalacia Subglottic tracheal webs Endotracheal, endobronchial tumors Subglottic tracheal stenosis
