STRIDOR AND SNORING

STRIDOR AND SNORING: Excerpt from Differential Diagnosis in Primary Care

Both these symptoms are the result of the same pathophysiologic mechanism: obstruction in the upper air passages. That obstruction may be due to any one of the etiologies recalled by the mnemonic MINT. M—Malformations that may cause snoring or stridor include a large tongue, large tonsils and adenoids, a large soft palate, a cleft palate, congenital webs of the glottis, and malformation of the epiglottis (causing the well-known congenital laryngeal stridor). Foreign bodies must be considered here, as well as laryngeal stenosis. I—Inflammatory conditions obstructing the upper airway include purulent sputum, acute laryngitis of diphtheria, acute tonsillitis, epiglottitis as in H. influenza, rhinitis, hay fever, acute laryngotracheitis (usually of viral origin), Ludwig angina, and angioneurotic edema. Whooping cough should also be remembered here. N—Neoplasms and neurologic disorders causing stridor or snoring include laryngeal polyps and carcinomas and bulbar or pseudobulbar palsy from basilar artery occlusions or hemorrhage, poliomyelitis or encephalitis, myasthenia gravis, and tabes dorsalis. T—Traumatic disorders include the passage of an endotracheal tube, tracheotomies, and karate chops to the larynx.

Approach to the Diagnosis

The approach to the diagnosis involves a careful examination of the air passage with the laryngoscope and bronchoscope (if necessary, under anesthesia). If these have negative findings, a thorough neurologic examination should be performed and a Tensilon test may be indicated. Laryngismus stridulus in children may be terminated by putting the child in a steam bath; this helps to establish that diagnosis. Skin testing for allergies may be necessary. A sleep study is often necessary to rule out neurogenic or obstructive sleep apnea.

Other Useful Tests

1. CBC (secondary polycythemia)
2. Nose and throat culture (chronic rhinitis or sinusitis)
3. Nasal smear for eosinophils (allergic rhinitis)
4. Acetylcholine receptor antibody (myasthenia gravis)
5. X-ray of the sinuses (sinusitis)
6. Otolaryngology consult
7. Neurology consult

Pictures

Book Source Details

• Book Title: Differential Diagnosis in Primary Care
• Author(s): R. Douglas Collins MD, FACP
• Year of Publication: 2007
• Copyright Details: Differential Diagnosis in Primary Care, Copyright © 2007 Lippincott Williams & Wilkins.

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Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.

More About This Book: Title: Differential Diagnosis in Primary Care Authors: R. Douglas Collins MD, FACP Publisher: Lippincott Williams & Wilkins Copyright: 2007 ISBN: 0-7817-6812-8

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