An example of how one can incorporate video images into educational material on the web, When used in the future this site would include a more thorough description of the illness, as well as the links you see here to pertinent articles. You may need quicktime 4.0 to view this. It can be downloaded from the Apple web-site (There are plug-ins for Mac, Windows, and Unix machines).

Stridor

Stidor is the audible breath sound heard due to turbulent airflow through the trachea and larger airways. There are many different etiologies, and these vary depending on whether the stridor is greater on Inspiration, Expiration or both.

Here is an example of a patient with both Inspiratory and Expiratory stridor

In this patient's case, the stridor is due to tracheobroncho-malacia, a state in which soft tracheal cartilage does not provide enough support to the airway during changes in intra and extra thoracic pressure associated with normal breathing. This is not uncommonly found in children with chronic illness, and can be associated with congenital heart disease and tracheo-esophageal fistulas. A variety of techniques have been employed to improve airway malacia, including pexy procedures in which the aorta is tacked to the anterior chest wall to relieve vascular compression. Airway stents are used at some institutions, but these have problems with the potential to erode into large blood vessels, and are notoriously difficult to remove when no longer needed.

With time, good health and good nutrition, these patients can lay down enough cartilage to overcome their severe malacia, but this can take a few years. In some cases a temporizing tracheotostomy is placed to allow positive pressure ventilation until enough time has passed to allow for adequate growth.

Croup is a more common cause of stridor. Click on the image below to see a sequence of both quiet and noisy breathing in a patient with croup and sub-glottic stenosis.

Note the marked sternal retractions. Although present during quiet breathing, worsen when the patient is agitated. As you may have noticed this patient's stridor is worse during inspiration. This suggests an abnormality of the airway outside of the thorax, as pressures on the airway during inspiration would tend to open up the trachea and decrease the likelihood of stridor.

Last updated January 4, 2000.

Video Information: used with permission of the patient's family. Consent on file.
Images obtained with: Sony DCR TRV-7 Digital CamCorder
Editing and compression using: Final Cut Pro v1.1 from Apple Computing and
Quicktime 4.0 Pro
on an Apple Macintosh G3 450MHZ tower
Initial movie size: 74.2MB
Compressed streamed size: 856K