Complicated Paediatric Bronchial Foreign Body: A Novel Extraction Technique

A paediatric bronchoscopy procedure for foreign body inhalation is indeed a highly challenging procedure due to multiple risk factors such as lower physiological functional residual capacity and adverse pulmonary function effects by anaesthetic agents in addition to concurrent active lungs infection. Here we elucidate a novel technique of foreign body removal located at the distal airway in a paediatric patient and in a situation where a paediatric flexible bronchoscopy with built-in working channel is not available. A 1-year 7-months-old boy presented with acute respiratory distress syndrome following a one-week history of active respiratory infection. On examination, he was tachypnoeic with audible soft inspiratory stridor and intermittent barking cough despite being supplemented with 3 liters /minute oxygen mask. Chest x-ray showed right upper lobe collapse. He was referred to the otorhinolaryngology team after a suspicious history of foreign body aspiration obtained from his mother. Bedside flexible nasopharyngolaryngoscopy showed granulation tissue at the junction of laryngeal surface of epiglottis and anterior commissure. He underwent emergency direct laryngoscopy, tracheoscopy, bronchoscopy, excision of granulation tissue and removal of foreign body under general anaesthesia. Herein, some of complicated bronchoscopy demand critical thinking of alternative or modified techniques to achieve a successful and safe surgery. Bangladesh J Otorhinolaryngol 2021; 27(2): 177-183

Croup as a manifestation of COVID-19 in infancy: a case series

The second wave of the COVID-19 pandemic in India brought with it an emerging clinical spectrum of the infection in children. Amongst these is the rarely reported presentation of croup, which otherwise remains a common clinical condition in infants caused by a variety of viruses and seen by pediatricians regularly. Airway manifestations of COVID-19 require reporting and unless their evaluation brings up any specific peculiarities, it is imperative to screen all such children presenting to the emergency department for SARS-CoV-2 infection. We hereby reported a series of three infants who were brought to us with typical features of croup including a mild fever, runny nose and indicators of subglottic inflammation including a hoarse voice, brassy cough and an inspiratory stridor. Each of them responded to conventional therapies for croup. However, the added conundrum of possible SARS-CoV-2 infection increases the relevance of rapid screening, assessment for complications and counselling in children presenting with croup.

MSC 2021 Virtual E-Abstract

1. Hiccups: An Atypical Presentation Of Lateral Medullary Syndrome2. Ouch, We Be Burnin’ Ya: A Case Report On Central Poststroke Pain Syndrome - Dejerine-Roussy Syndrome.3. Stroke Severity, Onset-to-Door Time, Door-to-Needle Time Comparison : Pre & During COVID19 Era In A District Hospital.4. Intravenous Thrombolysis In Acute Stroke In Stroke Ready Hospitals Without Neurologists: Beneficial Effects In Nihss And Mrs Improvements.5. Acute Inspiratory Stridor As An Unusual Presentation Of Brainstem Stroke.6. Overview Of Ischemic Stroke Management Following Stroke Code Activation Pathway At District Hospital.7. Onset To Treatment Time of Ischaemic Stroke Thrombolysis And Functional Outcome In A District Hospital.

Thyroglossal cyst in elderly: a rare cause of inspiratory stridor

<p class="abstract">Thyroglossal cyst is the most common congenital anterior neck swelling in childhood. Commonly present as painless swelling in the 2nd decade of life but the cases are reported in the elderly age group also. It represents the persistent epithelial tract from the foramen cecum to the thyroid gland. Clinically can be diagnosed and can be differentiated with other mid-line swelling by movement with the protusion of tongue. It is usually related to the hyoid bone and may be supra-hyoid, infra-hyoid, lower part of the midline or rarely lingual in position. Ultrasonography is the investigation of choice for this cystic condition. It is safe, economical and easily available investigation among all the radiological study. MRI is helpful to diagnose cervical extension and lingual cyst. Inspite of close relation to the laryngeal structure it rarely present as laryngeal mass and causes stridor or sleep apnea as in our case. Classic Sistrunk procedure is the treatment of choice for the condition. Endoscopic CO2 Laser is useful in situation where only intraoral cyst present without cervical extension. Marsupialization is reserved for lingual cyst especially in Neonate. We are reporting this case which was present in the elderly and reported with long standing anterior neck swelling with inspiratory stridor on lying down position.</p>

Recurrent stridor in an infant

Paediatric upper airway obstruction is an emergency that requires immediate intervention. Among the myriad factors that leads to upper airway obstruction in paediatric age group, bilateral vocal cord palsy is not commonly encountered in clinical practice. The underlying cause of bilateral vocal cord palsy requires thorough investigation prior to deciding on the appropriate intervention. Herein, we report a 4-month-old baby boy who presented with recurrent inspiratory stridor with bilateral vocal cord palsy secondary to Arnold Chiari II malformation. Immediate intervention to drain the hydrocephalous resulted in complete resolution of stridor without having to perform a tracheostomy. We highlight the importance of meticulous and thorough investigations especially in children, as emergent airway intervention such as tracheostomy may result in detrimental effect to speech, swallowing as well as quality of life.

Congenital laryngeal cyst causing respiratory distress in a neonate: a rare case report

Congenital laryngeal cyst is a rare but responsible of upper airway obstruction which can be potentially life-threatening. The most common symptoms are inspiratory stridor, dyspnea, cyanosis, abnormal voice and difficulty with feeding. It should be differentiated from laryngomalacia. It is diagnosed by flexible fibro-optic laryngoscopy. Surgical options are endoscopic excision, needle aspiration, de-roofing, external laryngo-fissure and lateral pharyngotomy. The best treatment consists in the entire removal of the cyst. This case report described the case of 28 days old neonate with a severe airway distress and stridor caused by a congenital laryngeal cyst which has been managed by de-roofing of the cyst entirely with flexible laryngoscope.

Pharmacological treatment of the patients with croup

Background: Croup is a respiratory illness usually caused by acute viral infection of the larynx, trachea, and bronchi, and characterized by the abrupt onset of a barking cough, inspiratory stridor, hoarseness, and respiratory distress due to upper airway obstruction. Croup commonly affects children younger than 6 years of age, with peak incidence between 7 and 36 months. Although the disease is usually self-limited, it may occasionally become life threatening, and can, on rare occasion, lead to respiratory failure.Current Concepts: Treatment of viral croup depends on the severity of symptoms as denoted by Westley croup score (i.e., mild, moderate, or severe). A single dose of oral or intramuscular dexamethasone (0.15-0.6 mg/kg) is the mainstay of treatment for viral croup, irrespective of severity. A single dose of nebulized budesonide (2 mg) is equally effective as systemically administered dexamethasone, and is considered when a patient is unable to take a medicine orally. Nebulized L-epinephrine (1:1,000, 3-5 mL) causes vasoconstriction in the mucosa, rapidly reducing airway edema. Addition of nebulized L-epinephrine is indicated in the patients with croup of at least moderate severity, displaying chest retraction and signs of labored breathing.Discussion and Conclusion: The most effective pharmacological treatments for patients with viral croup are oral or intramuscular dexamethasone, and nebulized L-epinephrine. Especially, corticosteroids can significantly decrease the intensity of croup symptoms and reduce hospital admissions, return visits to emergency department and length of stay in the hospital.

When Inspiratory Stridor Is Not Paradoxical Vocal Fold Motion/Inducible Laryngeal Obstruction: A Case Study of Diaphragm Flutter

Purpose This case study describes the clinical course for an individual referred to a speech-language pathologist (SLP) for assessment and treatment of paradoxical vocal fold motion/inducible laryngeal obstruction (PVFM/ILO) who was ultimately diagnosed with diaphragm flutter. This case presentation describes the critical importance of a multidisciplinary approach to identify conditions in the differential diagnosis of PVFM/ILO, which may lead to timely diagnosis and treatment of such conditions. Method Using a case study format with links to pre- and posttreatment videos, the clinical course of a 20-year-old woman presenting with persistent inspiratory stridor and cough during waking time was delineated. Data used to determine the differential diagnosis included careful clinical observation, extensive medical history, and endoscopic laryngeal assessment. Results Using a multidisciplinary approach with professionals from three different treatment centers, the diagnosis of diaphragm flutter was affirmed and successful medical management with an empiric trial of Baclofen was initiated with complete resolution of the dyspnea, cough, and inspiratory stridor over 3 weeks. Conclusions This case study describes a rare condition in the differential diagnosis of PVFM/ILO called diaphragm flutter, characterized by persistent inspiratory stridor and cough that interrupted connected speech and swallowing. SLPs who specialize in the assessment and treatment of PVFM/ILO may encounter this condition. Clinician awareness of the clinical profile for diaphragm flutter is critical for rapid referral to the appropriate medical specialists to achieve timely symptom relief. Supplemental Material https://doi.org/10.23641/asha.14781867

Vallecula-cyste: een zeldzame oorzaak van progressief toenemende inspiratoire stridor bij een neonaat

Vallecular cyst: a rare cause of progressive inspiratory stridor in a neonate The medical history of an infant with progressive inspiratory stridor caused by a vallecular cyst is presented. The cyst was diagnosed via a laryngoscopy and treated by means of an excision. The postoperative course was complicated by severe stridor induced by post-intubation edema. This report elaborates on the clinical presentation and work-up. The differential diagnosis of neonatal stridor is exhaustive. A congenital vallecular mass rarely causes it. These masses can manifest in various ways. Symptoms usually develop during the first week(s) of life. Key symptoms are upper airway obstruction and feeding difficulties. Life threatening situations are also possible. Given that the exact etiology of vallecular cysts remains unclear, different hypotheses were proposed. The differential diagnosis should include a dermoid cyst, a thyroglossal duct cyst, a teratoma, an hemangioma or lingual thyroid. The diagnosis usually requires a flexible and/or direct laryngoscopy. Radiographic imaging may also contribute to the work-up, adding information about the anatomical dimensions (for example with regard to the surrounding structures), the exact location, the magnitude, the content, etc. The definitive diagnosis is made through pathological evaluation. Different treatment options are proposed, preferably endoscopic excision or marsupialization.