Differential Diagnosis for Stridor in a Child with a Tongue Abnormality

• Single most likely diagnosis:
  • Laryngomalacia: This is the most common cause of stridor in infants and is often associated with other anatomical abnormalities, including those of the tongue. The condition involves softening of the tissues of the larynx, which can cause partial airway obstruction when inhaling.
• Other Likely diagnoses:
  • Macroglossia: An abnormally large tongue can cause obstruction of the airway, leading to stridor. This condition can be congenital or acquired due to various causes such as hypothyroidism or Beckwith-Wiedemann syndrome.
  • Glossoptosis: This condition involves the tongue falling back and obstructing the airway, which can be associated with micrognathia (small jaw) or other craniofacial abnormalities. It can cause stridor, especially when the child is in a supine position.
• Do Not Miss diagnoses:
  • Epiglottitis: Although less common in the era of vaccination against Haemophilus influenzae type b, epiglottitis is a life-threatening condition that requires immediate recognition and treatment. It can cause stridor due to inflammation and swelling of the epiglottis.
  • Foreign body aspiration: This is an emergency that can cause sudden onset of stridor. It's crucial to consider this diagnosis, especially in toddlers who are prone to putting objects in their mouths.
• Rare diagnoses:
  • Tumor of the tongue or oropharynx: Although rare, tumors in this area can cause stridor by obstructing the airway. Examples include hemangiomas or rhabdomyosarcomas.
  • Congenital anomalies of the larynx or trachea: Conditions such as laryngeal webs, subglottic stenosis, or tracheal stenosis can cause stridor. These are rare but important to consider in the differential diagnosis of a child with stridor and tongue abnormalities.