Stridor in children (causes, inspiratory and expiratory stridor, pathophysiology)

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"Stridor is a sound predominantly heard during inspiration. It is caused by partial obstruction of the large airways that results in turbulent airflow in the respiratory passage. Stridor is defined as high-pitched, monophonic sound and is usually loud and can be heard without a stethoscope. The differential diagnosis of stridor is vast with croup being the most common cause of acute stridor and laryngomalacia being the most common chronic or congenital cause of stridor congenital.
When thinking about pathophysiology of stridor it’s good to think of the respiratory tract in terms of extrathoracic region and intrathoracic region.
As a general rule inspiratory stridor occurs in the extrathoracic region and expiratory stridor occurs from obstruction in the intrathoracic region.
During inspiration, air flows from the extrathoracic region into the intrathoracic region. When there is some airway obstruction anywhere in the extrathoracic region this will cause an inspiratory stridor because of the turbulent flow through respiratory tube. Most causes of stridor are found in the extrathoracic region.
During expiration air flows from the intrathoracic region through the extrathoracic region. If there is any obstruction in the small airways of the intrathoracic region it causes expiratory stridor. Expiratory stridor is much less common.
The causes of stridor can be divided into anatomical regions.
Extrathoracic region which is anywhere from the nose, to the larynx and trachea Intrathoracic which include distal trachea and bronchi"
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[@rigrentals5297]

OMG, i just had a pop quiz on Croup right now, and came to this video cause "stridor" was one of the answers. Will never forget this. thank you.

[@Dr_Ankur_Tripathi331]

Thanks sir ! Ur videos are highly recommended to all aspiring medicos !

[@worldaround6520]

Thanks *Why is stridor more common during inspiration?* Stridor is generally heard in larger airways that are outside the lungs. During inspiration, the pressure in the respiratory tree is negative. During expiration, the pressure in the respiratory tree is positive. When the pressure is negative, i.e., during inspiration, the trachea and other structures that produce stridor are more prone to collapse. This narrowed cross-sectional area leads to turbulent flow, producing sound. Stridor can also be heard during expiration, but it is less common and usually occurs in the part of the respiratory tree that is inside the lungs. The logic here is that during inspiration, the lungs expand, so any pathology that decreases the cross-sectional area is less pronounced; thus, the narrowing is less severe. Pathologies such as asthma, which affect smaller airways inside the lungs, also produce wheezing during expiration. During expiration, the lungs are smaller, so the narrowing of the smaller airways is even more pronounced.

[@howtomedicate]

A new video from my favorite youtuber You made my day! 👍

[@InsightfulScience]

Thanks Amando keep up the great work!

[@sthnwatch]

Thanks for the video. They're the best. Please keep them coming!

[@bethbroughton1668]

Fantastic as Always!

[@wc5709]

Thanks

[@kirtishrotriya7126]

Very simple Ed,thanks

[@ankitapatel4893]

thank...you...very much..sir.....for..all .vidios.. best wishes.....keep it up..sir..👍

[@Happy-yf8bc]

Expiratory stridor and wheeze are not the same right? How would you differentiate them?

[@xxchaosxx5]

thank you so much! this helped a lot

[@neurosurgerypassion2139]

hello armando ...how r u ??? ... after a really long time buddy ...:) ...hope u r doing fine ...hopig to c u more frequently ..bcos medicos across d gloe need u ....ryt nw armando crisis is goin on ...god bless u ...:) tq for ur videos ...am expecting some microbiology videos from u ...:)

[@normadicn5700]

You must be Ghanaian

[@favy116]

Thank you so much

[@aracely2025]

Great video 👍💚

[@hendrawanbakri9363]

Thanks a lot !!

[@AshwinNaik]

Thank you! Such amazing diagrams!

[@salehabdu3074]

You are the best. Thank you.

[@الدكتورسعدالبردوني]

Very very very nice thank you...

[@alstondsouza4]

Hypophax or epiglottis obstruction cure 😢 after styloidtecomy SURGURY i got this aspiration pnemonia !

[@gowrishankarp5299]

Beauty👌

[@medicobpkihs3996]

❤

[@beyondthestethoscope04]

Anyone here from Plabable?

[@hashimbanihashim5021]

👋

[@floflyberlin7392]

👌👍☺ Thank you.

[@atulprajapati5107]

Make videos.of anatomy, MBBS,1st,year, syllabus

[@nu.wa.n]

Why do you say inspiratory stridor is heard if the obstruction is only extrathoracic? Airflow doesn't suddenly stop after it enters Intrathoracic airways during inspiration.

[@AnalogGuy1]

Imagine an old-fashioned whistle. The obstruction is near the point at which air flows into, to make a sound. If you inspire, the obstruction must be near the point of air intake, extrathoracic. If you exhale, the sound-producing obstruction must be near the point at which the air originates, intrathoracic. Sucking on a whistle doesn't make a sound. As an engineer, I know that's hand-waving, but it creates a good visual image. To more rigorously answer your statement that airflow doesn't suddenly slow after it enters the intrathoracic airways during inspiration, we have to get specific about the word "airflow". Volumetric flow (cm^3/s) doesn't change after it enters the intrathoracic airway during inspiration (ignoring tiny differences caused by delta pressure), but as measured by velocity (cm/s) it drops off quite rapidly. Volumetric flow = velocity x cross sectional area (the dimensions work out, but better is the visual image of a river widening; total volumetric water flow in gallons/minute stays the same, but the velocity of the water drops as the river cross section widens and deepens). In the limit of going so deeply intrathoracic that you are in the lungs, you're eventually left with the cross-sectional area of the lungs; compared to the cross-sectional area of the trachea this is huge, so the velocity drops, just like the cross-sectional area of capillary flow vs. arterial. The ability to make a whistling sound is dependent upon the ratio of inertial forces to viscous forces (the Reynold's Number), which is dependent on airflow velocity, not volumetric flow.

[@medicinespeaking7713]

👌👌👌👌

[@ChevalierGroup-h4k]

that's not arytenoid its cricoid

[@bittermossie6965]

When Doctors say it resolves on it's own is the worst advice. Make sure to bottle feed with breastmilk and not breastfeed, otherwise the will struggle to gain weight because they are working harder than a normal baby. My baby is in ICU now because of this.

[@Polyglot0101]

Man. What a pain to the ears the accent and stressing. That fake unoriginal accent. Is this Armando or some other. 11 minutes felt like one hour. Armando’s voice and accent used to flow like music. This video is off. God.

[@aniketsingh5275]

Stridor is low pitch sounds. Not high pitched sir.