Diagnostic evaluation of congenital respiratory stridor in children

Introduction. Congenital respiratory stridor in children is the result of respiratory tract pathology located at various anatomical levels. There is an ongoing debate on whether every case of stridor requires diagnostic evaluation and which method is the most effective for determining the final diagnosis. Aim. The aim of the present study is to answer the question which procedure should be performed to diagnose the casuse of congenital stridor in children and why, and what the most common cause of the stridor is. Material and methods. A group of 110 children examined due to congenital respiratory stridor was analysed. The children’s general condition was assessed and imaging studies and lower respiratory tract endoscopy were performed under general anaesthesia. In some children cardiac ultrasound and contrast-enhanced radiographic examination of the oesophagus or contrast-enhanced computed tomography scan of the chest were performed. Results. Children aged 3 days to 11 years were analysed. The most common cause of stridor was congenital laryngeal hypotonia found in 50% of children and the second most common was abnormalities of the great arteries in 28% of children. Biphasic stridor, which may be a sign of multiple respiratory abnormalities, was diagnosed most frequently. It was only lower respiratory tract endoscopy performed under general anaesthesia that made it possible to make the right diagnosis. Conclusions. The most useful diagnostic method for congenital respiratory stridor is lower respiratory tract endoscopy under general anaesthesia, which is used to evaluate both the larynx and the trachea since defects may coexist at various respiratory levels. It is also for this reason that the type of stridor is not tantamount to the level at which the pathology is located in the respiratory tract. One needs to bear in mind that abnormalities of the great arteries may also be the cause of congenital respiratory stridor.