STRIDOR

Question 1

what are the 3 manifestations of stridor WITH respiratory effort issues?

Answer 1

DDSP
EE
LH

Question 2

When does Stridor manifest?

Answer 2

ONLY during exercise - NORMAL at rest

Question 3

Does DDSP = Elongated soft palate?

Answer 3

FUCK NO!

you can call it choking up, swallow tongue, or flip palate

Question 4

What are the 2 types of DDSP

Answer 4

intermittent (multifactoral)

persistant (neuro)

Question 5

What does DDSP happen?

Answer 5

“HIRT”

• Hypoplastic epiglottis (shorter in length +/- flaccid)
  Upper/Lower airway disease
• Inflammation (collapse of pharynx)
• Retraction of tongue/larynx (extensive head flexion)
• Thyrohyoid muscle dysfunction (important for stabilization of soft palate & larynx)

Question 6

What are the CS of DDSP?

Answer 6

Exercise intolerance/quitting
expiratory (~30% no noise) – CHEEK puffing!!
- “choking noise” - gurgling, fluttering, rattling, snoring
coughing while eating
head/neck extension

Question 7

Who is predisposed to get DDSP?

Answer 7

nervous/tense horse

Question 8

How do we DX DDSP? What do we see?

Answer 8

Endoscopy – epiglottis ventral to soft palate for >8 sec during high speed treadmill exercise
        =PUH (pooh)
- Pharyngeal hyperplasia
- Ulceration (from repeated trauma)
- Hypoplastic epiglottis

Question 9

How do we DX DDSP?

What are the conservative tx?

What are the sx tx?

Answer 9

Tx underlying cz (ROA, Pharyngitis)
Conservative
- Change poll flexion
- Tongue TIE
- TSD = Throat support devices (cornell collar)
Surgical
- Laryngeal TIE FORWARD
- Sternothyroid myectomy
- Soft-palate thermoplasty - Trim CD margin of soft palate
- Epiglottis augmentation

Question 10

What can cause EE (epiglottic entrapment?)

Answer 10

Loose epiglottis tissues
Hypoplastic epiglottis (~30%)
DDSP

Question 11

What are the CS of EE?

Answer 11

Asymptomatic
Exercise intolerance Inspiratory
expiratory resp noise
Chronic cough esp. when EATING??? - check this
 head/neck extension

Question 12

How do you dx EE?

Answer 12

Endoscopy – loss of scalloped edge of epiglottis

- Ulcer (occasional) – esp if chronic (~45%)

Question 13

How do you tx EE (conservative and surgical examples please…)?

Answer 13

Conservative
- Stall rest (~1 wk) +/- anti-
inflammatories
Surgical
- Cutting
- Laser
- Some epiglottis augmentation

Question 14

What Side is associated with idiopathic LH?

Answer 14

LEFT

Question 15

How the fuck does LH happen?

Answer 15

Paralysis of arytenoids + high – pressure = axial displacement ® ̄ rima glottis space

Question 16

Who is predisposed to getting LH?

Answer 16

Young 2-3 yr; can be in 5-6 yr

Question 17

What are the CS associated with LH?

Answer 17

inspiratory noise = “roaring”

Question 18

How do we DX LH?

Answer 18

Endoscopy (at rest & exercise)
- Minimal restraint, NO sedation
- Grade
- “Slap test”
Palpate larynx
Arytenoid depression test
Grunt test – cant close glottis/maintain airtight seal Intra-mandibular width
Electrolaryngeography

Question 19

How do we TX LH (conservative and surgical examples please…)?

Answer 19

conservative
NONE - fooled ya!

Surgical
- Tie BACK – laryngoplasty +
ventriculocordectomy
- Laryngeal re-innervation
- arytenoidectomy

Question 20

What can LH cause?

Answer 20

DDSP

Question 21

What can DDSP cause?

Answer 21

EE