Juvenile nasopharyngeal angiofibroma| aetiology, diagnosis, treatment

Definition: Difficult noisy respiration indicating partial airway obstruction in larynx &/or  trachea.

Types: 

a. Inspiratory laryngeal: at or above glottis.

b. Biphasic: subglottic or tracheal.

c. Expiratory: bronchial.

Causes of stridor:

I. Congenital:

• Congenital web 
• Laryngo malacia.
• Subglottic stenosis
• Subglottic haemangioma.
• Congenital cyst 
• Congenital bilateral cord palsy

II. Traumatic:

• Mechanical: Sharp, blunt, surgical, intubation, F.B.
• Physical: Radiotherapy, thermal.
• Chemical: Corrosives.

III. Inflammatory:

• Acute non-specific laryngitis, in children
• Acute epiglottitis.
• Acute laryngotracheobronchitis in children.
• Laryngeal diphtheria.
• Chronic specific laryngitis (granulomas)

IV. Neoplastic

• Benign: Multiple papillomatosis, subglottic chondroma.
• Malignant: Carcinoma.

V. Miscellaneous

• Neurological: Bilateral abductor paralysis. Laryngeal spasm e.g. tetany
• Tumor like conditions: Laryngeal cysts, laryngocele, amyloidosis.
• Laryngeal oedema.

VI. Tracheal causes

• Retrosternal goiter, mediastinal LN, thymus hyperplasia,& deep neck infection

Clinical picture of stridor:

• Dyspnea & tachypnea.
• Irritability, restlessness, fatigue, sweating.
• Working alae nasi.
• Suprasternal, supraclavicular & intercostal retraction.
• Working accessory muscles of respiration.
• Tachycardia.
• Congested neck veins.
• Late: Cyanosis, and bradycardia. Finally: coma & cardiac arrest.

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