Laryngeal congenital stridor: causes, symptoms, diagnosis, treatment

Laryngeal congenital stridor is a syndrome that appears immediately after birth or in the first weeks of life of a newborn. This syndrome is characterized by a pronounced impairment of the respiratory function of the larynx, accompanied by a stridor sound.

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What causes laryngeal congenital stridor?

Causes of congenital laryngeal stridor may include:

1. compression of the trachea by a hypertrophied thymus or thyroid gland, or compression of the bronchus by the aortic trunk or pulmonary arteries;
2. malformations of the epiglottis, tissues of the vestibule of the larynx, thyroid cartilage or tracheal rings, cysts and diaphragm of the larynx, macroglossia, micrognathia with dislocation of the tongue towards the entrance to the larynx;
3. congenital laryngeal papillomatosis;
4. paralysis of the recurrent nerves and ankylosis of the cricoarytenoid joints resulting from intrapartum trauma.

Laryngeal congenital stridor occurs in the so-called laryngomalacia, in which the laryngeal cartilages are very soft and elastic formations, which causes them to be drawn into the lumen of the larynx during inhalation under the influence of "negative" pressure. The epiglottis is especially intensely drawn into the lumen of the larynx, which causes its obstruction and a stridor sound during inhalation. These organic and functional disorders in laryngomalacia are observed in children with rickets, whose mothers during pregnancy did not follow a diet that promotes normal fetal development (deficiency of vitamins, calcium, phosphorus and other microelements, carbohydrates), or suffered from some disease that adversely affects the development of the unborn child. Laryngeal congenital stridor can be caused by spasmophilia, which is also one of the manifestations of rickets, i.e. a disorder of calcium metabolism.

Symptoms of congenital laryngeal stridor

The main symptom of congenital laryngeal stridor is a characteristic loud sound that occurs during inhalation in a falsetto tone when air breaks through the spasmodic larynx. During exhalation, this sound takes on the character of high-frequency white noise, similar to that used to mask hearing. Stridor is detected immediately after birth or after several weeks. During sleep, its severity decreases, and during crying and screaming of the child, it increases. Inhalation is more difficult than exhalation. In such children, the sonority of the voice outside of an attack of stridor is not impaired. During stridor, breathing is impaired with the appearance of signs of asphyxia: cyanosis, disorientation in the surrounding environment, failure to recognize close people, up to loss of consciousness, in which, however, the spasm of the larynx passes, and the child's condition returns to normal. Attacks of laryngeal congenital stridor occur periodically with varying frequency for 2-3 months after birth and, if they are caused by functional disorders, their severity gradually decreases and completely disappears by the end of the 2nd year of life.

How is congenital laryngeal stridor recognized?

Diagnosis is not difficult, but the diagnosis can be definitively established only after direct laryngoscopy and tracheobronchoscopy, and in some cases after a thorough X-ray examination of the child. Differential diagnosis is carried out with true and false croup, vulgar laryngitis, laryngeal papillomatosis, retropharyngeal abscess and other volumetric processes in the larynx and neck.

Treatment of congenital laryngeal stridor

Treatment of laryngeal congenital stridor consists of providing the child with a normal mental environment, adequate nutrition, and measures to normalize vitamin and mineral metabolism. Serious attention is paid to the prevention of acute respiratory infections.

Laryngeal congenital stridor has a favorable prognosis, except in cases of acute stenosis or severe structural defects of the larynx, in which case the prognosis becomes serious.