MyMedR

Aetiology of stridor in Malaysian children

Elango S, Htun YN

Ann Trop Paediatr, 1994;14(4):329-32.

Eighty-five children who presented with stridor were reviewed in order to determine the aetiology of stridor in these cases. Congenital causes accounted for 57.6% of cases. Laryngomalacia was the commonest congenital abnormality (77.5%). Other common causes of stridor were a foreign body in the airway (acquired) and laryngotracheobronchitis (33.3%) (infective). Tracheostomized children are a problem in developing countries, requiring prolonged hospitalization. We overcome this problem by teaching parents how to maintain the tracheostomy tube at home.

Matched MeSH terms: Respiratory Sounds/diagnosis; Respiratory Sounds/etiology*

A survey on automated wheeze detection systems for asthmatic patients

Shaharum SM, Sundaraj K, Palaniappan R

Bosn J Basic Med Sci, 2012 Nov;12(4):249-55.

PMID: 23198941

The purpose of this paper is to present an evidence of automated wheeze detection system by a survey that can be very beneficial for asthmatic patients. Generally, for detecting asthma in a patient, stethoscope is used for ascertaining wheezes present. This causes a major problem nowadays because a number of patients tend to delay the interpretation time, which can lead to misinterpretations and in some worst cases to death. Therefore, the development of automated system would ease the burden of medical personnel. A further discussion on automated wheezes detection system will be presented later in the paper. As for the methodology, a systematic search of articles published as early as 1985 to 2012 was conducted. Important details including the hardware used, placement of hardware, and signal processing methods have been presented clearly thus hope to help and encourage future researchers to develop commercial system that will improve the diagnosing and monitoring of asthmatic patients.

Matched MeSH terms: Respiratory Sounds/diagnosis*

Fourth branchial pouch cyst: an unusual cause of neonatal stridor

Sharma HS, Razif A, Hamzah M, Dharap AS, Mahbar Z, Kamal MZ, et al.

Int J Pediatr Otorhinolaryngol, 1996 Dec 20;38(2):155-61.

PMID: 9119603

Fourth branchial pouch anomalies are extremely rare and only a few such cases showing sinuses and cystic masses have been reported in the literature. We describe a patient who presented on the third day of life with cystic neck swelling of fourth branchial pouch origin giving rise to respiratory obstruction and stridor. Despite repeated aspiration of the cystic mass to relieve respiratory obstruction, rapid recurrence of the mass continued to cause stridor and ultimately required surgical excision. The clinical, radiological, and histopathological findings of this unusual condition are discussed with a review of the literature.

Matched MeSH terms: Respiratory Sounds/etiology*

Recurrent stridor in an infant

Ngu CYV, Saniasiaya J, Kulasegarah J

BMJ Case Rep, 2021 Sep 07;14(9).

PMID: 34493558 DOI: 10.1136/bcr-2021-244012

Paediatric upper airway obstruction is an emergency that requires immediate intervention. Among the myriad factors that leads to upper airway obstruction in paediatric age group, bilateral vocal cord palsy is not commonly encountered in clinical practice. The underlying cause of bilateral vocal cord palsy requires thorough investigation prior to deciding on the appropriate intervention. Herein, we report a 4-month-old baby boy who presented with recurrent inspiratory stridor with bilateral vocal cord palsy secondary to Arnold Chiari II malformation. Immediate intervention to drain the hydrocephalous resulted in complete resolution of stridor without having to perform a tracheostomy. We highlight the importance of meticulous and thorough investigations especially in children, as emergent airway intervention such as tracheostomy may result in detrimental effect to speech, swallowing as well as quality of life.

Matched MeSH terms: Respiratory Sounds/etiology

A Rare Case of Pseudomembranous Tracheitis Presenting as Acute Stridor in a Patient after Extubation

Ong HY, Ng JJ, Nadhrah MN, Shaariyah MM, Shashi G

Turk Arch Otorhinolaryngol, 2020 Jun;58(2):130-132.

PMID: 32783042 DOI: 10.5152/tao.2020.5095

Pseudomembranous tracheitis is a rare life-threatening complication of endotracheal intubation. The exact mechanism of its formation is not well known, and it could mimic crusting or retained secretions in the trachea. We encountered a patient with history of recent intubation, presenting with acute stridor requiring emergency airway stabilization, and was eventually found to have pseudomembranous tracheitis.

Matched MeSH terms: Respiratory Sounds

Fulltext The dilemma of a lateral pharyngeal mass causing stridor in a neonate

Dipak RN, Kailesh P, Sherry MJ, Anindya C

Med J Malaysia, 2005 Oct;60(4):520-2.

PMID: 16570723

Neonatal stridor resulting from intrinsic or extrinsic aberration in the upper respiratory tract often poses not only a diagnostic problem, but also a difficult airway and a dilemma as to the necessity / timing of surgical intervention. A 45 day old female child with increasing stridor since birth was managed by emergency intubation and CT scan followed by excision biopsy of the cystic left sided parapharyngeal mass via a transcervical approach. On histopathology, the excised specimen was reported as cystic salivary choristoma.

Matched MeSH terms: Respiratory Sounds/diagnosis; Respiratory Sounds/etiology

Fulltext Point-of-Care Airway Ultrasonography Prior to an Emergency Cricothyroidotomy: Case Report

Iqhbal M, Noor JM, Karim NA, Ismail I, Sanib H, Mokhtar MA, et al.

Sultan Qaboos Univ Med J, 2018 May;18(2):e219-e222.

PMID: 30210855 DOI: 10.18295/squmj.2018.18.02.017

The use of ultrasonography in acute and critical care medicine is becoming increasingly common. However, use of an airway ultrasound as an adjunct to determine the type of intervention needed and assess complications is not common practice. We report a 56-year-old male who presented to the Emergency Department of the Sungai Buloh Hospital, Selangor, Malaysia, in 2015 with hoarseness, stridor and impending respiratory failure. A point-of-care ultrasound performed to assess the neck and vocal cords indicated a heterogeneous echogenic mass in the larynx, thus ruling out a cricothyroidotomy. The patient was therefore referred for an emergency tracheostomy. This case highlights the importance of point-of-care airway ultrasonography in the assessment of patients with stridor. This imaging technique not only helps to detect the cause of the stridor, but also to determine the feasibility of a cricothyroidotomy in emergency cases.

Matched MeSH terms: Respiratory Sounds/diagnosis*; Respiratory Sounds/etiology

Fulltext Congenital vallecular cyst with polydactyly - A rare cause of stridor and failure to thrive

Khode SR, Gosrani N, Golhar S, Vedi J

Med J Malaysia, 2014 Apr;69(2):101-2.

PMID: 25241823

Congenital vallecular cyst is an uncommon, benign but potentially dangerous condition causing respiratory distress and stridor. It is associated with sudden upper airway obstruction resulting in death due to its anatomical location in neonates and infants. We reported a rare case of 2 months old male infant presented with respiratory obstruction with failure to thrive with polydactyly (rarest finding) and managed timely with appropriate surgical marsupialization.

Matched MeSH terms: Respiratory Sounds

Fulltext Tell tale of tablets in bronchus

Shimpi T, Chawla A, Shikhare S

Med J Malaysia, 2015 Feb;70(1):36-7.

PMID: 26032528

Foreign body (FB) aspiration is an emergency of concern at all ages. However, in adults, it can present with atypical symptoms such as shortness of breath, wheezing or rarely cyanosis. Aspiration of oral medications is seen in the elderly population with impairment of protective airway mechanism. Treatment of choice is endoscopic removal of the foreign body. We report such a case of foreign body aspiration (potassium chloride tablet), diagnosed on imaging and subsequently developed bronchostenosis. There are a very few reported cases of oral potassium supplement aspiration and associated complications in the literature.

Matched MeSH terms: Respiratory Sounds

Cervical lipoblastoma: An uncommon presentation

Jaafar R, Tang IP, Jong DE, Narihan MZ

Ear Nose Throat J, 2015 Jul;94(7):E8-10.

PMID: 26214680

Lipoblastoma is extremely rare and mainly occurs in children younger than 3 years old. It is predominantly found in the extremities and trunk. Head and neck region occurrences are rare; only 4 such cases involving patients who presented with stridor have been previously reported. We report the fifth case of lipoblastoma of the neck with stridor in a 9-year-old girl, which had gradually worsened over the previous year. Imaging showed a retrotracheal mass extending superiorly to the thyroid level and inferiorly to below the carina of the trachea. Total resection of the tumor was performed, and the histopathologic findings were consistent with lipoblastoma. Postoperatively, the patient was well with no complications.

Matched MeSH terms: Respiratory Sounds

Fulltext Revisiting asthma phenotype in children

Fahisham Taib

Malaysian Journal of Paediatrics and Child Health, 2011;17(1):0-0.

MyJurnal

Asthma is considered as heterogeneous multidimensional disorder due to variable phenotypic presentation. Phenotype is defined as a cluster of either clinical or pathologic features, which tends to be associated with the understanding the mechanisms of the disease. Asthma is typically characterized by airway inflammation, variable airway obstruction, bronchial hyper-reactivity, smooth muscle hypertrophy and apparent reversible airflow obstruction by bronchodilators. ‘Asthma syndrome’ is a term to describe complex pathophysiology of the condition which is not exclusive to allergen triggered episodes. Diagnosing childhood asthma is difficult, due to the similarity of symptoms and overlapping with other wheezing conditions. The precise mechanism for asthma exacerbation, for each individual phenotype is not fully understood. However, it is influenced by genetic interaction with variety of external environmental stimuli. The current understanding on asthma phenotypes were interpreted based on age of onset, associated triggers, clinical aspects, physiologic parameters and type of inflammation (Table 1). Due to the illdefined of the current phenotypic definition and disagreement among the respirologists, it is becoming a challenge to label specific phenotype with certainty. Accurate definition of each phenotype should therefore be helpful to provide better understanding of different mechanistic pathways and focusing on targeted therapy for individual phenotype. (Copied from article).

Matched MeSH terms: Respiratory Sounds

Fulltext Extracranial carotid aneurysm secondary to Takayasu Arteritis (TA): a rare complication

Irfan Mohamad, Ikhwan Sani Mohamad, Prahalad Ramanathan, Win Mar@Salmah

Malaysian Journal of Medicine and Health Sciences, 2015;11(2):89-92.

MyJurnal

Extracranial aneurysms are a rare presentation accounting for only less than 5% of all peripheral artery
aneurysms. The left common carotid artery aneurysm is considered even rarer. We present a case of a 46-year-old gentleman who presented to casualty unit with a neck mass, stridor and acute respiratory distress. Prior to this admission patient was being investigated for Takayasu arteritis (TA). Patient was subsequently intubated due to respiratory compromise. A CT angiography of the thorax was done
showed a proximal left common carotid artery aneurysm with contained leakage of aneurysm with
severe compression of the trachea. Patient was subsequently transferred to the vascular team in National Heart Institute for further management.

Matched MeSH terms: Respiratory Sounds

Fulltext Respiratory symptoms in tea mill workers

Naemah Tajol Arus, Suhaily Amran, Norhafsam Maghpor, Ahmad Sayuti Zainal Abidin, Nurzuhairah Jamil, Rochi Bakel, et al.

Journal of Occupational Safety and Health, 2015;12(1):221-225.

MyJurnal

In the recent years, an extensive number of scientific researches on occupational diseases have been done to
identify occupations at high risk of inducing diseases. There are many categories of occupational diseases, and unitary
of them are occupational respiratory diseases. This study was conducted in a tea factory located in Cameron Highlands,
Malaysia, with an output of 600,000.00 kg per annum. Its objective was to evaluate respiratory diseases among the
workers, conducted via questionnaires, interviews and lung functional tests. A total of 38 workers participated in this
study, 19 in the exposed group and 19 in the control group. The most common chronic symptoms for the exposed
group are wheezing, dyspnea (short of breath) and phlegm. The result shows that, among the tea processing workers,
the exposed group suffer from respiratory diseases.

Matched MeSH terms: Respiratory Sounds

Fulltext Indoor microbiome, microbial and plant metabolites, chemical compounds, and asthma symptoms in junior high school students: a multicentre association study in Malaysia

Sun Y, Zhang M, Ou Z, Meng Y, Chen Y, Lin R, et al.

Eur Respir J, 2022 Nov;60(5).

PMID: 35618276 DOI: 10.1183/13993003.00260-2022

BACKGROUND: Indoor microbial exposure is associated with asthma, but the health effects of indoor metabolites and chemicals have not been comprehensively assessed.

METHODS: We collected classroom dust from 24 junior high schools in three geographically distanced areas in Malaysia (Johor Bahru, Terengganu and Penang), and conducted culture-independent high-throughput microbiome and untargeted metabolomics/chemical profiling.

RESULTS: 1290 students were surveyed for asthma symptoms (wheeze). In each centre, we found significant variation in the prevalence of wheeze among schools, which could be explained by personal characteristics and air pollutants. Large-scale microbial variations were observed between the three centres; the potential protective bacteria were mainly from phyla Actinobacteria in Johor Bahru, Cyanobacteria in Terengganu and Proteobacteria in Penang. In total, 2633 metabolites and chemicals were characterised. Many metabolites were enriched in low-wheeze schools, including plant secondary metabolites flavonoids/isoflavonoids (isoliquiritigenin, formononetin, astragalin), indole and derivatives (indole, serotonin, 1H-indole-3-carboxaldehyde), and others (biotin, chavicol). A neural network analysis showed that the indole derivatives were co-occurring with the potential protective microbial taxa, including Actinomycetospora, Fischerella and Truepera, suggesting these microorganisms may pose health effects by releasing indole metabolites. A few synthetic chemicals were enriched in high-wheeze schools, including pesticides (2(3H)-benzothiazolethione), fragrances (2-aminobenzoic acid, isovaleric acid), detergents and plastics (phthalic acid), and industrial materials (4,4-sulfonyldiphenol).

CONCLUSIONS: This is the first association study between high-throughput indoor chemical profiling and asthma symptoms. The consistent results from the three centres indicate that indoor metabolites/chemicals could be a better indicator than the indoor microbiome for environmental and health assessments, providing new insights for asthma prediction, prevention and control.

Matched MeSH terms: Respiratory Sounds

Fulltext An unexpected cause of hoarseness of voice in a healthy teenager

Wong SL, Ibrahim ZA

Malays J Med Sci, 2010 Jan;17(1):52-5.

PMID: 22135527 MyJurnal

Laryngeal amyloidosis is a rare cause of stridor in a healthy young adult. We report a case of localised laryngeal amyloidosis, including our MRI findings, which included a necrotic centre that has not previously been described. This case also highlights the need for a high index of clinical suspicion to achieve the correct histopathological interpretation.

Matched MeSH terms: Respiratory Sounds

Fulltext Two cases of congenital vallecular cyst: a reminder of the potentially fatal cause of upper airway obstruction in infants

Abd Aziz A, Abdullah AF, Ahmad RA

Malays J Med Sci, 2010 Jul;17(3):68-73.

PMID: 22135553 MyJurnal

Vallecular cyst, a benign yet rare laryngeal lesion, may cause stridor and even life-threatening upper airway obstruction in infants. It can cause apnoea and poor feeding habits, thus reducing the chance of survival. Although laryngomalacia remains the most common cause of stridor in this age group, awareness and a high level of suspicion for this condition can help lead to early management and intervention. Direct laryngoscopy is accepted as the gold standard for diagnostic purposes, and marsupialisation of the cyst is the preferred treatment. We describe 2 cases of vallecular cysts in infants admitted to our hospital where timely diagnoses led to appropriate treatment.

Matched MeSH terms: Respiratory Sounds

Fulltext Laser posterior cordectomy for bilateral abductor vocal cord palsy : a case report

Mohamad I, Jihan WS, Mohamad H, Abdullah B

Malays J Med Sci, 2008 Jan;15(1):42-3.

PMID: 22589614

Bilateral abductor vocal cord palsy is comparatively a rare vocal cord lesion, especially in a patient with no history of neck mass, previous surgery or trauma. Many patients are not stridulous. A patient presenting with stridor may need emergency airway management before the other treatment is commenced. We report a case of bilateral abductor palsy which required an emergency tracheostomy and subsequently a laser posterior cordectomy.

Matched MeSH terms: Respiratory Sounds

Fulltext Bilateral vocal cord palsy post thyroidectomy: lessons learnt

Misron K, Balasubramanian A, Mohamad I, Hassan NF

BMJ Case Rep, 2014;2014.

PMID: 24663247 DOI: 10.1136/bcr-2013-201033

Bilateral vocal cord paralysis is a known possible complication following thyroid surgery. It owes to the close relationship between the recurrent laryngeal nerve and the thyroid gland. The most feared complication of bilateral vocal cord paralysis is airway compromise. We report the case of a 39-year-old woman who underwent total thyroidectomy for multinodular goitre. The surgery was uneventful. However she developed stridor in the recovery bay needing intubation. We postulate that the cause was attributed to bilateral vocal cord paresis due to the use of the intraoperative nerve monitoring (IONM) whose high setting throughout the surgery was overlooked. She made a complete recovery without the need of a tracheostomy. We share our lessons learnt from this case.

Matched MeSH terms: Respiratory Sounds/etiology

An impacted fish bone in the subglottis manifesting as protracted stridor: photodocumentation

Rahmat O, Lim WK, Prepageran N

Ear Nose Throat J, 2007 May;86(5):264.

PMID: 17580799

Matched MeSH terms: Respiratory Sounds/etiology*

Fulltext Parents are poor at labelling wheeze in children: a cross-sectional study

Shanmugam S, Nathan AM, Zaki R, Tan KE, Eg KP, Thavagnanam S, et al.

BMC Pediatr, 2016 06 23;16:80.

PMID: 27339265 DOI: 10.1186/s12887-016-0616-8

BACKGROUND: Noisy breathing is a common presenting symptom in children. The purpose of this study is to (a) assess parental ability to label wheeze, (b) compare the ability of parents of children with and without asthma to label wheeze and (c) determine factors affecting parental ability to label wheeze correctly.

METHODS: This cross-sectional study in a tertiary hospital in Kuala Lumpur, Malaysia involved parents of children with asthma. Parents of children without asthma were the control group. Eleven validated video clips showing wheeze, stridor, transmitted noises, snoring or normal breathing were shown to the parents. Parents were asked, in English or Malay, "What do you call the sound this child is making?" and "Where do you think the sound is coming from?"

RESULTS: Two hundred parents participated in this study: 100 had children with asthma while 100 did not. Most (71.5 %) answered in Malay. Only 38.5 % of parents correctly labelled wheeze. Parents were significantly better at locating than labelling wheeze (OR 2.4, 95 % CI 1.64-3.73). Parents with asthmatic children were not better at labelling wheeze than those without asthma (OR1.04, 95 % CI 0.59-1.84). Answering in English (OR 3.4, 95 % CI 1.69-7.14) and having older children with asthma (OR 9.09, 95 % CI 3.13-26.32) were associated with correct labelling of wheeze. Other sounds were mislabelled as wheeze by 16.5 % of respondents.

CONCLUSION: Parental labelling of wheeze was inaccurate especially in the Malay language. Parents were better at identifying the origin of wheeze rather than labelling it. Physicians should be wary about parental reporting of wheeze as it may be inaccurate.

Matched MeSH terms: Respiratory Sounds/diagnosis*

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