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Bronchoscopic evaluation of chronic stridor in children aged 0-5 years: A study from a Pediatric Tertiary Care Centre from Eastern India.
Partha Pratim Halder, Jigna Bathia, Aniruddha Ghosh, Subhajit Dey Sarkar*, Ritabrata Kundu, Apurba Ghosh
Background: Stridor is an abnormal, high-pitched monophonic sound, produced by turbulent airflow in a narrowed airway. Its presence suggests significant obstruction of the large airways at the level of the supraglottis, glottis, subglottis or trachea. Stridor can be acute, subacute or chronic. Acute stridor may be due to croup, epiglottis, bacterial tracheitis, and anaphylaxis or due to a foreign body aspiration. Chronic stridor is mainly due to anatomical deformities. There are few studies in the pediatric population regarding bronchoscopic findings in children presenting with chronic stridor.
Aim: To determine the causes of chronic stridor in children less than 5 years using flexible Fibre-Optic Bronchoscopy (FOB).
Method: This retrospective study was conducted from May 2019 to December 2021; 58 children aged less than five years with chronic stridor had undergone FOB within this period. Stridor has been divided into three groups: Inspiratory, expiratory and biphasic. Patients were analyzed regarding sex distribution, cause of stridor and clinical findings. Radiologic investigation reports were included wherever relevant.
Results: Amongst the 58 children, 61% were boys and 39% were girls. The common symptoms associated with chronic stridor were cough (51.7%), breathlessness (32.2%) and fever (19%). The most common sign associated with stridor was tachypnea (82.7%). 22 patients had inspiratory stridor, 30 had biphasic stridor and 6 had expiratory stridor. Of the 58 children with chronic stridor, 44 (75.8%) had abnormal FOB findings. Laryngomalacia was the most common abnormality (31%) followed by subglottic stenosis (15.5%) and tracheomalacia (12%).
Conclusion: In this study of chronic stridor in children aged less than five years, laryngomalacia was the commonest abnormality found on flexible FOB followed by subglottic stenosis and tracheomalacia.