# Stridor

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High-pitched breathing sound due to obstruction of the larynx

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Medical condition

Stridor Inspiratory and expiratory stridor in a 13-month child with croup, recorded via electronic stethoscope Specialty Otorhinolaryngology, pediatrics

**Stridor** (from [Latin](/source/Latin_language) *stridere* 'to grate, screech') is an extra-[thoracic](/source/Thoracic_cavity) high-pitched [breath sound](/source/Respiratory_sounds) resulting from [turbulent](/source/Turbulent) air flow in the [larynx](/source/Larynx) or elsewhere in the [upper respiratory tract](/source/Upper_respiratory_tract). It is different from [stertor](/source/Stertor), which is a snoring noise originating in the [pharynx](/source/Pharynx), and [wheezing](/source/Wheeze), which originates in the [bronchi](/source/Bronchus).

Stridor is a physical sign which is caused by a narrowed or [obstructed airway](/source/Airway_obstruction). It can be [inspiratory](/source/Inhalation), [expiratory](/source/Exhalation) or [biphasic](/source/Biphasic_disease), although it is usually heard during inspiration. Inspiratory stridor often occurs in children with [croup](/source/Croup). It may be indicative of serious airway obstruction from severe conditions such as [epiglottitis](/source/Epiglottitis), a foreign body lodged in the airway, or a laryngeal tumor. Stridor should always command attention to establish its cause. Visualization of the airway by medical experts equipped to control the airway may be needed.

## Causes

Stridor may occur as a result of:

- foreign bodies (e.g., [aspirated](/source/Pulmonary_aspiration) [foreign body](/source/Foreign_body), aspirated food bolus);

- infections (e.g., [epiglottitis](/source/Epiglottitis), [retropharyngeal abscess](/source/Retropharyngeal_abscess), [croup](/source/Croup));

- subglottic [stenosis](/source/Stenosis) (e.g., following prolonged intubation or congenital);

- airway edema (e.g., following instrumentation of the airway, [tracheal intubation](/source/Tracheal_intubation), drug side effect, [allergic reaction](/source/Allergic_reaction));

- [laryngospasm](/source/Laryngospasm) (from aspiration, [GERD](/source/GERD), or complication of [anesthesia](/source/Anesthesia));

- subglottic [hemangioma](/source/Hemangioma) (rare);

- [vascular rings](/source/Vascular_rings) compressing the trachea;

- [thyroiditis](/source/Thyroiditis) such as [Riedel's thyroiditis](/source/Riedel's_thyroiditis);

- [vocal cord](/source/Vocal_cord) palsy;

- [tracheomalacia](/source/Tracheomalacia) or [tracheobronchomalacia](/source/Tracheobronchomalacia) (e.g., collapsed trachea);

- [congenital](/source/Congenital) anomalies of the airway, present in 87% of all cases of stridor in infants and children;[1]

- [vasculitis](/source/Vasculitis);

- [infectious mononucleosis](/source/Infectious_mononucleosis);

- [peritonsillar abscess](/source/Peritonsillar_abscess);

- laryngeal edema, a common cause of stridor post extubation (occurring from pressure of the endotracheal tube on the [mucosa](/source/Mucosa) as a result of endotracheal tube that is too large (e.g. pediatrics), cuff over inflation, and prolonged intubation times);[2]

- tumor (e.g., laryngeal papillomatosis, [squamous cell carcinoma](/source/Squamous_cell_carcinoma) of larynx, trachea or esophagus);

- [ALL](/source/Acute_lymphoblastic_leukemia) ([T-cell ALL](/source/T-cell_ALL) can present with mediastinal mass that compresses the trachea and causes inspiratory stridor).

## Diagnosis

Stridor is mainly diagnosed on the basis of history and physical examination, with a view to revealing the underlying problem or condition.

Chest and neck [x-rays](/source/X-rays), [bronchoscopy](/source/Bronchoscopy), [CT-scans](/source/CT-scans), and/or [MRIs](/source/MRIs) may reveal structural pathology.

Flexible fiberoptic [bronchoscopy](/source/Bronchoscopy) can also be very helpful, especially in assessing vocal cord function or in looking for signs of compression or infection.

## Treatments

The first issue of clinical concern in the setting of stridor is whether or not [tracheal intubation](/source/Tracheal_intubation) or [tracheostomy](/source/Tracheostomy) is immediately necessary. A reduction in oxygen saturation is considered a late sign of airway obstruction, particularly in a child with healthy lungs and normal gas exchange. Some patients will need immediate tracheal intubation. If intubation can be delayed for a period, a number of other potential options can be considered, depending on the severity of the situation and other clinical details. These include:

- Expectant management with full monitoring, oxygen by face mask, and positioning the head on the bed for optimum conditions (e.g., 45 - 90 degrees).

- Use of [nebulized](/source/Nebulizer) [racemic epinephrine](/source/Racepinefrine) (0.5 to 0.75 ml of 2.25% racemic epinephrine added to 2.5 to 3 ml of normal saline) in cases where airway edema may be the cause of the stridor. (Nebulized [Codeine](/source/Codeine) in a dose not exceeding 3 mg/kg may also be used, but not together with racemic adrenaline [because of the risk of ventricular arrhythmias].)

- Use of [dexamethasone](/source/Dexamethasone) ([Decadron](/source/Decadron)) 4–8 mg IV q 8 - 12 h in cases where airway edema may be the cause of the stridor; note that some time (in the range of hours) may be needed for dexamethasone to work fully.

- Use of inhaled [Heliox](/source/Heliox) (70% [helium](/source/Helium), 30% [oxygen](/source/Oxygen)); the effect is almost instantaneous. Helium, being a less dense gas than nitrogen, reduces turbulent flow through the airways. Always ensure an open airway.

In obese patients, elevation of the [panniculus](/source/Panniculus) has shown to relieve symptoms by 80%.

## References

1. **[^](#cite_ref-pmid7436240_1-0)** Holinger LD (1980). "Etiology of stridor in the neonate, infant and child". *Ann. Otol. Rhinol. Laryngol*. **89** (5 Pt 1): 397–400. [doi](/source/Doi_(identifier)):[10.1177/000348948008900502](https://doi.org/10.1177%2F000348948008900502). [PMID](/source/PMID_(identifier)) [7436240](https://pubmed.ncbi.nlm.nih.gov/7436240). [S2CID](/source/S2CID_(identifier)) [20514618](https://api.semanticscholar.org/CorpusID:20514618).

1. **[^](#cite_ref-2)** Wittekamp, Bastiaan HJ. Clinical review: Post-extubation laryngeal edema and extubation failure in critically ill adult patients. Crit Care. 2009; 13(6): 233.

## External links

Look up ***[stridor](https://en.wiktionary.org/wiki/Special:Search/stridor)*** in Wiktionary, the free dictionary.

- [Audio Breath Sounds](http://respwiki.com/Breath_sounds) [Archived](https://web.archive.org/web/20201215121532/http://respwiki.com/Breath_sounds) 2020-12-15 at the [Wayback Machine](/source/Wayback_Machine)—Multiple case studies with audio files of lung sounds.

- *[Stridor](http://www.emedicine.com/ped/topic2159.htm#)* at [eMedicine](/source/EMedicine)

- *[Congenital stridor](http://www.emedicine.com/ped/topic2624.htm#)* at [eMedicine](/source/EMedicine)

- *[MedlinePlus Encyclopedia](/source/MedlinePlus)*: [Breathing sounds—abnormal (stridor)](https://medlineplus.gov/ency/article/003074.htm)

- [Diseases Database](/source/Diseases_Database) (DDB): [27190](http://www.diseasesdatabase.com/ddb27190.htm)

- [Stridor sounds at R.A.L.E. Lung Sounds](http://www.rale.ca/Stridor.htm)

Classification D ICD-10: R06.1 ICD-9-CM: 786.1 External resources MedlinePlus: 003074 Patient UK: Stridor

v t e Signs and symptoms relating to the respiratory system Auscultation Stethoscope Respiratory sounds Stridor Wheeze Crackles Rhonchi Stertor Squawk Pleural friction rub Fremitus Bronchophony Death rattle Elicited findings Percussion Pectoriloquy Whispered pectoriloquy Egophony Breathing Rate Apnea Prematurity Sleep Dyspnea Hyperventilation Hypoventilation Hyperpnea Tachypnea Hypopnea Bradypnea Pattern Agonal respiration Biot's respiration Cheyne–Stokes respiration Kussmaul breathing Ataxic respiration Other Respiratory distress Respiratory arrest Orthopnea/Platypnea Trepopnea Aerophagia Asphyxia Breath holding Mouth breathing Snoring Vocal fold Aphonia Muteness Selective Phoneme Dysphonia Hypophonia Other Chest pain In children Precordial catch syndrome Pleurisy Nail clubbing Cyanosis Cough Sputum Hemoptysis Epistaxis Silhouette sign Post-nasal drip Hiccup COPD Hoover's sign asthma Curschmann's spirals Charcot–Leyden crystals chronic bronchitis Reid index sarcoidosis Kveim test pulmonary embolism Hampton hump Westermark sign pulmonary edema Kerley lines Hamman's sign Golden S sign

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