MyMedR

Fourth branchial pouch cyst: an unusual cause of neonatal stridor

Sharma HS, Razif A, Hamzah M, Dharap AS, Mahbar Z, Kamal MZ, et al.

Int J Pediatr Otorhinolaryngol, 1996 Dec 20;38(2):155-61.

PMID: 9119603

Fourth branchial pouch anomalies are extremely rare and only a few such cases showing sinuses and cystic masses have been reported in the literature. We describe a patient who presented on the third day of life with cystic neck swelling of fourth branchial pouch origin giving rise to respiratory obstruction and stridor. Despite repeated aspiration of the cystic mass to relieve respiratory obstruction, rapid recurrence of the mass continued to cause stridor and ultimately required surgical excision. The clinical, radiological, and histopathological findings of this unusual condition are discussed with a review of the literature.

Matched MeSH terms: Respiratory Sounds/etiology*

Aetiology of stridor in Malaysian children

Elango S, Htun YN

Ann Trop Paediatr, 1994;14(4):329-32.

PMID: 7880097

Eighty-five children who presented with stridor were reviewed in order to determine the aetiology of stridor in these cases. Congenital causes accounted for 57.6% of cases. Laryngomalacia was the commonest congenital abnormality (77.5%). Other common causes of stridor were a foreign body in the airway (acquired) and laryngotracheobronchitis (33.3%) (infective). Tracheostomized children are a problem in developing countries, requiring prolonged hospitalization. We overcome this problem by teaching parents how to maintain the tracheostomy tube at home.

Matched MeSH terms: Respiratory Sounds/etiology*

Recurrent stridor in an infant

Ngu CYV, Saniasiaya J, Kulasegarah J

BMJ Case Rep, 2021 Sep 07;14(9).

PMID: 34493558 DOI: 10.1136/bcr-2021-244012

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.

Matched MeSH terms: Respiratory Sounds/etiology

Fulltext Bilateral vocal cord palsy post thyroidectomy: lessons learnt

Misron K, Balasubramanian A, Mohamad I, Hassan NF

BMJ Case Rep, 2014;2014.

PMID: 24663247 DOI: 10.1136/bcr-2013-201033

Bilateral vocal cord paralysis is a known possible complication following thyroid surgery. It owes to the close relationship between the recurrent laryngeal nerve and the thyroid gland. The most feared complication of bilateral vocal cord paralysis is airway compromise. We report the case of a 39-year-old woman who underwent total thyroidectomy for multinodular goitre. The surgery was uneventful. However she developed stridor in the recovery bay needing intubation. We postulate that the cause was attributed to bilateral vocal cord paresis due to the use of the intraoperative nerve monitoring (IONM) whose high setting throughout the surgery was overlooked. She made a complete recovery without the need of a tracheostomy. We share our lessons learnt from this case.

Matched MeSH terms: Respiratory Sounds/etiology

An impacted fish bone in the subglottis manifesting as protracted stridor: photodocumentation

Rahmat O, Lim WK, Prepageran N

Ear Nose Throat J, 2007 May;86(5):264.

PMID: 17580799

Matched MeSH terms: Respiratory Sounds/etiology*

Fulltext The dilemma of a lateral pharyngeal mass causing stridor in a neonate

Dipak RN, Kailesh P, Sherry MJ, Anindya C

Med J Malaysia, 2005 Oct;60(4):520-2.

PMID: 16570723

Neonatal stridor resulting from intrinsic or extrinsic aberration in the upper respiratory tract often poses not only a diagnostic problem, but also a difficult airway and a dilemma as to the necessity / timing of surgical intervention. A 45 day old female child with increasing stridor since birth was managed by emergency intubation and CT scan followed by excision biopsy of the cystic left sided parapharyngeal mass via a transcervical approach. On histopathology, the excised specimen was reported as cystic salivary choristoma.

Matched MeSH terms: Respiratory Sounds/etiology

Fulltext Acute stridor in childhood; retropharyngeal abscess

Yeo TC

Med J Malaysia, 1988 Mar;43(1):65-73.

PMID: 3244324

Thirty-eight patients with acute stridor were admitted to the Paediatric Unit of the Alor Setar General Hospital over a three-year period (1984 - 1986). The causes are discussed and retropharyngeal abscess is highlighted as it is often initially overlooked. The clinical presentation and the problems in the diagnosis of the latter are discussedwith reference to the three cases seen.
Key words: Acute stridor in childhood, retropharyngeal abscess

Matched MeSH terms: Respiratory Sounds/etiology

Fulltext Point-of-Care Airway Ultrasonography Prior to an Emergency Cricothyroidotomy: Case Report

Iqhbal M, Noor JM, Karim NA, Ismail I, Sanib H, Mokhtar MA, et al.

Sultan Qaboos Univ Med J, 2018 May;18(2):e219-e222.

PMID: 30210855 DOI: 10.18295/squmj.2018.18.02.017

The use of ultrasonography in acute and critical care medicine is becoming increasingly common. However, use of an airway ultrasound as an adjunct to determine the type of intervention needed and assess complications is not common practice. We report a 56-year-old male who presented to the Emergency Department of the Sungai Buloh Hospital, Selangor, Malaysia, in 2015 with hoarseness, stridor and impending respiratory failure. A point-of-care ultrasound performed to assess the neck and vocal cords indicated a heterogeneous echogenic mass in the larynx, thus ruling out a cricothyroidotomy. The patient was therefore referred for an emergency tracheostomy. This case highlights the importance of point-of-care airway ultrasonography in the assessment of patients with stridor. This imaging technique not only helps to detect the cause of the stridor, but also to determine the feasibility of a cricothyroidotomy in emergency cases.

Matched MeSH terms: Respiratory Sounds/etiology

Fulltext Supraglottoplasty for laryngomalacia: who will benefit?

Zainal A, Goh BS, Mohamed AS

Asian J Surg, 2011 Apr;34(2):92-6.

PMID: 21723473 DOI: 10.1016/S1015-9584(11)60026-2

Laryngomalacia is the most common cause of neonatal and infantile stridor. The aim of this study was to assess the outcome of surgical intervention in children with laryngomalacia.

Matched MeSH terms: Respiratory Sounds/etiology

Bronchiolitis obliterans in children: clinical profile and diagnosis

Chan PW, Muridan R, Debruyne JA

Respirology, 2000 Dec;5(4):369-75.

PMID: 11192548

The aim of the study was to determine the clinical profile, aetiology and radiological categories in children diagnosed with bronchiolitis obliterans (BO).

Matched MeSH terms: Respiratory Sounds/etiology

Fulltext Risk factors for wheeze in the last 12 months in preschool children

Quah BS, Mazidah AR, Simpson H

Asian Pac J Allergy Immunol, 2000 Jun;18(2):73-9.

PMID: 10928618

Most children with asthma develop their symptoms before the age of 5 years and many preschool wheezers continue to wheeze in the early school years. It is thus important to investigate the factors that predispose young children to wheeze. The objective of this study was to investigate the relevant environmental and family influences on recent wheeze (wheeze within the last 12 months) in preschool children. A cross-sectional study was conducted in five primary health clinics in the district of Kota Bharu from April to October 1998. Nurses from these clinics distributed Bahasa Malaysia questionnaires containing questions on asthma symptoms, environmental risk factors, family's social status and family history of atopy and wheeze to preschool children aged 1-5 years during their home visits. The respondents were parent(s) or carer(s) of the children. A total of 2,524 (87.7%) complete questionnaires were available for analysis of risk factors. One hundred and fifty six (6.2%) children had current wheeze. Significant risk factors associated with current wheeze were a family history of asthma (O.R. = 6.36, 95% C.I. = 4.45-9.09), neonatal hospital admission (O.R. = 2.38, 95% C.I. = 1.51 - 3.75), and a maternal (O.R. = 2.12, 95% C.I. = 1.31-3.41) or paternal (O.R. = 1.52, 95% C.I. = 0.95-2.43) history of allergic rhinitis. Among environmental factors examined, namely, household pets, carpeting in bedroom, use of fumigation mats, mosquito coils and aerosol insect repellents, maternal and paternal smoking, and air conditioning, none were associated with an increased risk of wheeze. In conclusion, the strongest association with current wheeze was a family history of asthma. Also significant were neonatal hospital admission and a history of allergic rhinitis in either the mother or father. None of the environmental factors studied were related to current wheeze in preschool children.
Study site: Klinik Kesihatan, Kelantan, Malaysia

Matched MeSH terms: Respiratory Sounds/etiology*

Fulltext Absent pulmonary valve syndrome--a case report

Ram SP, Lim MK, Mazeni A

Med J Malaysia, 1994 Mar;49(1):93-5.

PMID: 8057999

A 7-year old female child was admitted for recurrent bronchopulmonary since one week of life. She was diagnosed to have ventricular septal defect and was treated conservatively. At seven years of life, repeat echocardiogram revealed a large perimembranous ventricular septal defect, absent pulmonary valve with overriding of aorta, narrow pulmonary artery annulus, and dilated main pulmonary artery and its branches. She was treated conservatively, discharged and follow-up at the National Heart Institute Kuala Lumpur, for corrective surgery.

Matched MeSH terms: Respiratory Sounds/etiology

A bizarre case of accessory larynx in an infant with OEIS syndrome

Wong TL, Baki MM, Ishak S, See GB

Int J Pediatr Otorhinolaryngol, 2018 Nov;114:134-137.

PMID: 30262351 DOI: 10.1016/j.ijporl.2018.08.037

We report a bizarre case of accessory larynx in an infant with OEIS syndrome (omphalocele, cloacal exstrophy, imperforated anus & spinal defects). This is the first reported case in literature of a duplicate accessory larynx which is a mirror image of the true larynx. A congenital duplication of the larynx is a rare anomaly and can present in various forms. In this case, the infant presented with recurrent lung infection and inability to wean off oxygen. Scope revealed severe laryngomalacia in addition to the accessory larynx. Hence, supraglottoplasty was done with aim to resolve the lung and airway problem.

Matched MeSH terms: Respiratory Sounds/etiology

Fulltext Epidemiology, clinical presentation and respiratory sequelae of adenovirus pneumonia in children in Kuala Lumpur, Malaysia

Li L, Woo YY, de Bruyne JA, Nathan AM, Kee SY, Chan YF, et al.

PLoS One, 2018;13(10):e0205795.

PMID: 30321228 DOI: 10.1371/journal.pone.0205795

OBJECTIVES: To describe the severity, human adenovirus (HAdV) type and respiratory morbidity following adenovirus pneumonia in children.

METHODOLOGY: Retrospective review of children under 12 years of age, admitted with HAdV pneumonia, between January 2011 and July 2013, in a single centre in Malaysia. HAdV isolated from nasopharyngeal secretions were typed by sequencing hypervariable regions 1-6 of the hexon gene. Patients were reviewed for respiratory complications.

RESULTS: HAdV was detected in 131 children of whom 92 fulfilled inclusion criteria. Median (range) age was 1.1 (0.1-8.0) years with 80% under 2 years. Twenty percent had severe disease with a case-fatality rate of 5.4%. Duration of admission (p = 0.02) was independently associated with severe illness. Twenty-two percent developed respiratory complications, the commonest being bronchiolitis obliterans (15.2%) and recurrent wheeze (5.4%). The predominant type shifted from HAdV1 and HAdV3 in 2011 to HAdV7 in 2013. The commonest types identified were types 7 (54.4%), 1(17.7%) and 3 (12.6%). Four out of the five patients who died were positive for HAdV7. Infection with type 7 (OR 8.90, 95% CI 1.32, 59.89), family history of asthma (OR 14.80, 95% CI 2.12-103.21) and need for invasive or non-invasive ventilation (OR 151.84, 95% CI 9.93-2.32E) were independent predictors of respiratory complications.

CONCLUSIONS: One in five children admitted with HAdV pneumonia had severe disease and 22% developed respiratory complications. Type 7 was commonly isolated in children with severe disease. Family history of asthma need for invasive or non-invasive ventilation and HAdV 7 were independent predictors of respiratory complications.

Matched MeSH terms: Respiratory Sounds/etiology

Respiratory health among office workers in Malaysia and endotoxin and (1,3)-β-glucan in office dust

Lim FL, Hashim Z, Than LTL, Md Said S, Hashim JH, Norbäck D

Int J Tuberc Lung Dis, 2019 11 01;23(11):1171-1177.

PMID: 31718753 DOI: 10.5588/ijtld.18.0668

OBJECTIVE: To examine the associations between endotoxin and (1,3)-β-glucan concentrations in office dust and respiratory symptoms and airway inflammation among 695 office workers in Malaysia.METHODS: Health data were collected using a questionnaire, sensitisation testing and measurement of fractional exhaled nitric oxide (FeNO). Indoor temperature, relative air humidity (RH) and carbon dioxide (CO₂) were measured in the offices and settled dust was vacuumed and analysed for endotoxin and (1,3)-β-glucan concentrations. Associations were analysed by two level multiple logistic regression.RESULTS: Overall, 9.6% of the workers had doctor-diagnosed asthma, 15.5% had wheeze, 18.4% had daytime attacks of breathlessness and 25.8% had elevated FeNO (≥25 ppb). The median levels in office dust were 11.3 EU/mg endotoxin and 62.9 ng/g (1,3)-β-glucan. After adjusting for personal and home environment factors, endotoxin concentration in dust was associated with wheeze (P = 0.02) and rhinoconjunctivitis (P = 0.007). The amount of surface dust (P = 0.04) and (1,3)-β-glucan concentration dust (P = 0.03) were associated with elevated FeNO.CONCLUSION: Endotoxin in office dust could be a risk factor for wheeze and rhinoconjunctivitis among office workers in mechanically ventilated offices in a tropical country. The amount of dust and (1,3)-β-glucan (a marker of indoor mould exposure) were associated with Th2 driven airway inflammation.

Matched MeSH terms: Respiratory Sounds/etiology

Iatrogenic tracheal flap mimicking tracheal stenosis with resultant stridor

Tan KL, Chong AW, Amin MA, Raman R

J Laryngol Otol, 2012 Jul;126(7):751-5.

PMID: 22578299 DOI: 10.1017/S0022215112000795

To illustrate a case of an iatrogenic mucosal tear in the trachea which caused a one-way valve effect, obstructing the airway and manifesting as post-extubation stridor.

Matched MeSH terms: Respiratory Sounds/etiology*

Fulltext Asthma, Airway Symptoms and Rhinitis in Office Workers in Malaysia: Associations with House Dust Mite (HDM) Allergy, Cat Allergy and Levels of House Dust Mite Allergens in Office Dust

Lim FL, Hashim Z, Than LT, Md Said S, Hisham Hashim J, Norbäck D

PLoS One, 2015;10(4):e0124905.

PMID: 25923543 DOI: 10.1371/journal.pone.0124905

A prevalence study was conducted among office workers in Malaysia (N= 695). The aim of this study was to examine associations between asthma, airway symptoms, rhinitis and house dust mites (HDM) and cat allergy and HDM levels in office dust. Medical data was collected by a questionnaire. Skin prick tests were performed for HDM allergens (Dermatophagoides pteronyssinus, Dermatophagoides farinae) and cat allergen Felis domesticus. Indoor temperature and relative air humidity (RH) were measured in the offices and vacuumed dust samples were analyzed for HDM allergens. The prevalence of D. pteronyssinus, D. farinae and cat allergy were 50.3%, 49.0% and 25.5% respectively. Totally 9.6% had doctor-diagnosed asthma, 15.5% had current wheeze and 53.0% had current rhinitis. The Der p 1 (from D. pteronyssinus) and Der f 1 (from D. farinae) allergens levels in dust were 556 ng/g and 658 ng/g respectively. Statistical analysis was conducted by multilevel logistic regression, adjusting for age, gender, current smoking, HDM or cat allergy, home dampness and recent indoor painting at home. Office workers with HDM allergy had more wheeze (p= 0.035), any airway symptoms (p= 0.032), doctor-diagnosed asthma (p= 0.005), current asthma (p= 0.007), current rhinitis (p= 0.021) and rhinoconjuctivitis (p< 0.001). Cat allergy was associated with wheeze (p= 0.021), wheeze when not having a cold (p= 0.033), any airway symptoms (p= 0.034), doctor-diagnosed asthma (p= 0.010), current asthma (p= 0.020) and nasal allergy medication (p= 0.042). Der f 1 level in dust was associated with daytime breathlessness (p= 0.033) especially among those with HDM allergy. Der f 1 levels were correlated with indoor temperature (p< 0.001) and inversely correlated with RH (p< 0.001). In conclusion, HDM and cat allergies were common and independently associated with asthma, airway symptoms and rhinitis. Der f 1 allergen can be a risk factor for daytime breathlessness.

Matched MeSH terms: Respiratory Sounds/etiology

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