Page 1882 - Cote clinical veterinary advisor dogs and cats 4th

Stridor and Stertor 945

When teaching clients how to brush teeth, soft) or by using feeding tubes. Knowledge of SUGGESTED READING
wait until after professional dental cleaning routine care of the tubes and administration Jennings MW, et al: Effect of tooth extraction on
VetBooks.ir • Full-mouth extraction requires a long Client Education AUTHOR: Ana C. Castejon-Gonzalez, DVM, PhD, Diseases and Disorders
of food through the tube are recommended.
has been performed and inflammation and
stomatitis in cats: 95 cases (2000-2013). J Am Vet
pain has been decreased by medical therapy.
Med Assoc 246:654, 2015.
duration of general anesthesia. To minimize
often controlled rather than cured. Some owners
anesthesia time, practice four-handed den- Clients should understand that stomatitis is DAVDC, DEVDC
EDITOR: Alexander M. Reiter, DVM, Dr. med. vet.,
tistry. Be ready and anticipate the surgeon’s may decline surgery because it seems too aggres- DAVDC, DEVDC
needs. sive or they believe that the patient cannot eat
• Cats and dogs with severe inflammation and without teeth. Sharing “happy ending stories”
oral pain need assisted nutrition by changing of other patients (pictures, owner’s comments)
the consistency of the food (slurry to slightly with them may decrease owner anxiety.

Stridor and Stertor Client Education
Sheet

BASIC INFORMATION • Clinical signs are often exacerbated by excite- tracheoscopy, and/or CT are often necessary
ment, high environmental temperature, or to determine the exact cause of the airway
Definition increased activity; animals may show no signs obstruction.
• Stridor: a harsh, high-pitched sound usually at rest.
occurring during inspiration that results from • Owner may report voice change with Differential Diagnosis
partial upper airway obstruction at or below laryngeal involvement. Owners may con- These noises are clinical signs, not disorders.
the larynx sider stertor a normal sound, especially in A list of stridor causes is provided on p. 1283.
• Stertor: a sonorous breathing sound similar brachiocephalic dogs.
to a snore that results from partial upper Initial Database
airway obstruction above the larynx (i.e., PHYSICAL EXAM FINDINGS • CBC, serum biochemistry profile, and
nasal passages, choanae, or nasopharynx) Abnormal sounds may be intermittent; other urinalysis: rule out systemic diseases
findings can include: • Stertor
Epidemiology • Stertor: nasal discharge, occlusion of airflow ○ Thorough examination of head, including
SPECIES, AGE, SEX from one or both nostrils, stenotic nares in oral and otic exams. Note nares/muzzle
More common in dogs than cats but occurs brachycephalic breeds, periodontal disease confirmation, symmetry, and color. Ret-
in both species with evidence of tooth root abscessation ropulse eyes, percuss sinus and muzzle,
or tooth loss; sound may disappear with and evaluate submandibular lymph
GENETICS, BREED PREDISPOSITION open-mouth breathing nodes.
• Brachycephalic dog breeds are predisposed • Stridor: coughing, gagging, dyspnea, hyper- ○ Assessing airflow through both nostrils,
to stertor. thermia, open-mouth gasping (inspiratory using a wisp of cotton ball or a cold glass
• Breed predispositions exist for laryngeal effort exaggerated), panting, paradoxical slide (warm, moist, expired air fogging the
paralysis (p. 574). breathing, unilateral discharge from the ear glass if the nasal passage is patent)
(sometimes seen in cats with nasopharyngeal • Stridor
RISK FACTORS polyps) ○ If severe open-mouth inspiratory
• Nasal/nasopharyngeal disorders through dyspnea: may be possible to visualize
primary obstruction (mass, foreign body Etiology and Pathophysiology caudal pharynx and larynx with patient
[FB], mucosal edema) or obstruction by • During inspiration, air pressure in the awake (e.g., pharyngeal FB, laryngeal/
discharge upper airway is low, allowing air to flow pharyngeal mass), using only a bright light
• Pharyngeal, laryngeal, and tracheal disorders in through the nares or mouth and fill the source
lungs. ○ Cervical radiographs to rule out laryngeal
ASSOCIATED DISORDERS • Obstruction narrows airway diameter, causing and tracheal masses and FBs. The normal
• Laryngeal paralysis, nasal and nasopharyngeal audible turbulence proximal to the obstruc- larynx (especially if mineralized and/or
tumors, nasopharyngeal polyps, brachioce- tion during inspiration. radiographed obliquely) should not be
phalic airway syndrome, airway FBs • Dynamic obstruction occurs when the airway misinterpreted as an FB
• Powerful, sustained inspirations against narrows on inspiration due to pressure effects; ○ Thoracic radiographs: intrathoracic trachea,
an obstructed upper airway are associated fixed obstruction exists regardless of phase lungs (rule out secondary noncardiogenic
with the development of noncardiogenic of respiration. pulmonary edema)
pulmonary edema. • Noise may be absent on expiration if the
pressure of exhaled air opens the airway Advanced or Confirmatory Testing
Clinical Presentation (e.g., laryngeal paralysis, other dynamic • Stertor
HISTORY, CHIEF COMPLAINT obstructions). ○ Thorough and complete oral/pharyngeal
• Owners may report these respiratory sounds exam under sedation/anesthesia
as a chief complaint or concurrently with DIAGNOSIS ○ Dental radiographs (apical dental/tooth
other signs of respiratory disease (cough- root abscesses)
ing, nasal discharge, sneezing, dyspnea, Diagnostic Overview ○ CT of nasal cavity and pharynx
epistaxis), pharyngeal disease (gagging, Physical exam and upper/lower airway ○ Rhinoscopy (p. 1159), including choanal
dysphagia), decreased exercise tolerance, or radiographs help localize the lesion causing exam with biopsies and cytologic exam if
syncope. respiratory stridor. Rhinoscopy, laryngoscopy, discharge is present

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