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Stridor is a high-pitched airway sound that can be produced from static or dynamic lesions along the upper airway. Airway fluoroscopy (AF) has been utilized as a diagnostic test to evaluate pediatric stridor, but prior studies have shown limitations. We aim to assess the reliability of airway fluoroscopy as compared to direct laryngoscopy and bronchoscopy (DLB) in evaluating pediatric stridor, with stratification of airway subsite. A retrospective chart review was performed. 184 patients were evaluated who had undergone both AF and DLB within one year of each other. Sensitivity and specificity were calculated at each airway subsite, including supraglottis, glottis, subglottis, trachea, and bronchi. Receiver operating characteristics (ROC) area under the curve (AUC) testing was performed at each subsite. Sensitivity and specificity were 12%/99%, 12%/98%, 44%/96%, and 39%/100% respectively for pathology at the level of the supraglottis, subglottis, trachea, and bronchi. ROC AUC was 0.558 ( p  < 0.05) for supraglottic pathology, 0.695 ( p  < 0.001) for tracheal pathology, and 0.676 ( p  < 0.001) for bronchial pathology. Airway fluoroscopy has poor sensitivity, but excellent specificity as a diagnostic test. Based on low ROC AUC values, airway fluoroscopy may not be a reliable screening test for the majority of stridulous patients; however, given its high specificity, low cost, and low risk profile it may be useful as an adjunct test in higher anesthetic risk populations or in patients where there is specific concern for tracheal or bronchial pathology.

Background Post-extubation stridor is a common complication of endotracheal intubation in ICU. This study aimed to assess whether a series of pre-extubation upper airway ultrasound measurements using shear wave elastography (SWE) could help in detecting post-extubation stridor. Methods A prospective observational study (NCT05611437) was conducted between 2022 and 2024, which consecutively included 150 adults ICU patients intubated for more than 24 h, without prior surgical or neurological upper airway disease nor swallowing disorders. SWE measurements were performed in the 24 h before extubation. The occurrence of post-extubation stridor, dysphonia and swallowing disorders were assessed within 72 h. Results 125 participants were included in the final analysis. A total of 2,625 ultrasound images were obtained, with 81% deemed interpretable. Post-extubation stridor occurred in 9% of patients and was independently associated with sepsis at admission (OR 8.98; 95%CI 1.3–62.1). No differences were observed between upper airway ultrasound in patients with or without stridor. Stridor was associated with higher rates of dysphonia (82% vs. 23%), swallowing disorders (36% vs. 11%), and extubation failure (46% vs. 10%). Swallowing disorders were independently associated with the duration of mechanical ventilation (OR 1.10; 95% CI 1.04–1.17). Dysphonia was associated with female sex (OR 3.23; 95%CI 1.24–8.37), sternothyroid muscle stiffness (OR 1.11; 95%CI 1.04–1.18), and days of mechanical ventilation (OR 1.09; 95%CI 1.02–1.15). Conclusion Oropharyngeal SWE is feasible in critically ill patients before extubation, but was not predictive of post-extubation stridor. Further studies are needed to explore its role in predicting post-extubation upper airway complications.

To characterize the sleep disorder of anti-IgLON5 disease. We reviewed 27 video-polysomnographies (V-PSG), 6 multiple sleep latency tests (MSLT), 2 videsomnoscopies with dexmedetomidine, and 10 actigraphies recorded during the disease course of five patients. Due to severe sleep architecture abnormalities, we used a novel modified sleep scoring system combining conventional stages with a descriptive approach in which two additional stages were identified: undifferentiated-NREM (UN-NREM) and poorly structured N2 (P-SN2) sleep that were characterized by abnormal motor activation and absence or sparse elements of conventional NREM sleep. Sleep-related vocalizations, movements, behaviors, and respiratory abnormalities were reported by bed-partners. In all patients, NREM sleep onset and sleep reentering after an awakening occurred as UN-NREM (median: 29.8% of total sleep time [TST]) and P-SN2 sleep (14.5% TST) associated with vocalizations and simple and quasi-purposeful movements. Sleep initiation was normalized in one patient with a high dose of steroids, but NREM sleep abnormalities reappeared in subsequent V-PSG. In all patients, if sleep continued uninterrupted, there was a progressive normalization with normal N2 (11.7% TST) and N3 (22.3% TST) sleep but stridor and obstructive apnea emerged. REM sleep behavior disorder (RBD) occurred in four patients. Sleep initiation was also altered in MSLT and dexmedetomidine-induced sleep. Actigraphy showed a 10-fold increase of nocturnal activity compared with controls. Sleep abnormalities remained stable during the disease. The sleep disorder of anti-IgLON5 disease presents as a complex sleep pattern characterized by abnormal sleep initiation with undifferentiated NREM sleep, RBD, periods of normal NREM sleep, stridor, and obstructive apnea.

Background Progressive encephalomyelitis with rigidity and myoclonus (PERM) is an acute, potentially life-threatening, yet curable neuro-immunological disease characterized by spasms, muscular rigidity, and brainstem and autonomic dysfunction. The clinical features of glycine receptor (GlyR) antibody-positive PERM may be overlooked, particularly with some unusual symptoms. Case presentation A 52-year-old man was admitted to the hospital for evaluation of tension headache for 20 days and mild dysarthria. These symptoms were followed by panic, profuse sweating, severe dysarthria, dizziness, unsteady gait, and paroxysmal muscle spasms. Brain magnetic resonance imaging and cerebrospinal fluid analysis were normal. The patient’s condition steadily deteriorated. He repeatedly presented with rigidity, panic attacks, severe anxiety, paroxysmal inspiratory laryngeal stridor, cyanosis of the lips, and intractable epilepsy. Electromyography showed multiple myoclonic seizures, a single generalized tonic-clonic seizure, and a single generalized tonic seizure. Screening for autoimmune encephalitis antibodies revealed anti-GlyR antibodies in his cerebrospinal fluid. Immunomodulatory pulse therapy with steroids and immunoglobulin resulted in expeditious improvement of the symptoms within 2 weeks, and a follow-up at 5 weeks showed consistent clinical improvement. Conclusion Our case highlights that inspiratory laryngeal stridor is an important symptom of PERM. Our observation widens the spectrum of the clinical presentation of anti-GlyR antibody-positive PERM, where early identification is a key to improving prognosis.

Introduction: Infantile subglottic hemangioma is a rare and serious condition characterized by stridor, respiratory distress, and a barking cough. This condition poses a significant risk as it can lead to life-threatening airway obstruction. Case Report: We present a patient who was diagnosed in the ED with moderate laryngomalacia via laryngoscopy by otolaryngology and discharged; he returned to the ED the next day with worsening symptoms of recurrent stridor, difficulty feeding, and worsening respiratory distress. A second laryngoscopic exam performed on the return ED visit revealed a subglottic mass which was later identified as a left-sided subglottic hemangioma via bronchoscopy and MRI. The patient was treated with propranolol and discharged from the inpatient unit with dermatology and otolaryngology follow-up. Conclusion: Infantile subglottic hemangioma is a rare but serious cause of respiratory distress in infants, posing a risk of airway obstruction. It should be considered in the ED, particularly for patients under two years of age, who present with recurrent stridor and respiratory distress and do not respond to standard treatments for croup or laryngomalacia.

Objective Post-extubation stridor and hoarseness are important clinical manifestations that indicate laryngeal edema due to intubation. In previous studies the incidence of post-extubation stridor and hoarseness ranged from 1.5% to 26.3% in postoperative patients and patients in the intensive care unit. Female sex and prolonged intubation are reportedly risk factors for post-extubation stridor. However, the risk factors for post-extubation stridor and the appropriate endotracheal tube size in emergency settings remain unknown. This study was performed to identify the risk factors for post-extubation laryngeal edema after emergency intubation. Methods A prospective observational study was conducted in a tertiary emergency medical center/trauma center. The primary outcome was post-extubation stridor and hoarseness. Results During the study period, 482 emergency intubations and 227 extubations were performed in adult patients. In total, 29% of the patients presented symptoms of stridor and/or hoarseness. Female sex (odds ratio, 2.65; 95% confidence interval, 1.21–5.81) and the duration of intubation (odds ratio, 1.18; 95% confidence interval, 1.05–1.32) were associated with stridor and/or hoarseness. Conclusions Patients who undergo emergency intubation have a higher risk of post-extubation upper airway obstruction symptoms than postoperative patients and patients in the intensive care unit, and female sex is associated with these symptoms.