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<title>Stridor</title>

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<span id="openzim-page-title" class="mw-page-title-main"><span class="mw-page-title-main">Stridor</span></span>

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</style><table class="infobox infobox-has-images-with-white-backgrounds"><tbody><tr><th colspan="2" class="infobox-above" style="background:#ccc">Stridor</th></tr><tr><td colspan="2" class="infobox-full-data"></td></tr><tr><td colspan="2" class="infobox-full-data">Inspiratory and expiratory stridor in a 13-month child with <a href="Croup" title="Croup">croup</a></td></tr><tr><th scope="row" class="infobox-label"><a href="Medical_specialty" title="Medical specialty">Specialty</a></th><td class="infobox-data"><a href="Otorhinolaryngology" title="Otorhinolaryngology">Otorhinolaryngology</a>, <a href="Pediatrics" title="Pediatrics">pediatrics</a></td></tr></tbody></table><style data-mw-deduplicate="TemplateStyles:r1236303919">

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<p><b>Stridor</b> (from <a href="Latin_language" class="mw-redirect" title="Latin language">Latin</a> <span class="gloss-quot">'</span><span class="gloss-text">creaking/grating noise</span><span class="gloss-quot">'</span>) is an extra-<a href="Thoracic_cavity" title="Thoracic cavity">thoracic</a> high-pitched <a href="Respiratory_sounds" title="Respiratory sounds">breath sound</a> resulting from <a href="Turbulent" class="mw-redirect" title="Turbulent">turbulent</a> air flow in the <a href="Larynx" title="Larynx">larynx</a> or lower in the <a href="Bronchial_tree" class="mw-redirect" title="Bronchial tree">bronchial tree</a>. It is different from a <a href="Stertor" title="Stertor">stertor</a>, which is a noise originating in the <a href="Pharynx" title="Pharynx">pharynx</a>.

</p><p>Stridor is a physical sign which is caused by a narrowed or <a href="Airway_obstruction" title="Airway obstruction">obstructed airway</a>. It can be <a href="Inhalation" title="Inhalation">inspiratory</a>, <a href="Exhalation" title="Exhalation">expiratory</a> or <a href="Biphasic_disease" title="Biphasic disease">biphasic</a>, although it is usually heard during inspiration. Inspiratory stridor often occurs in children with <a href="Croup" title="Croup">croup</a>. It may be indicative of serious airway obstruction from severe conditions such as <a href="Epiglottitis" title="Epiglottitis">epiglottitis</a>, 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.

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<div class="mw-heading mw-heading2"><h2 id="Causes">Causes</h2></div>

<p>Stridor may occur as a result of:

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<ul><li>foreign bodies (e.g., <a href="Pulmonary_aspiration" title="Pulmonary aspiration">aspirated</a> <a href="Foreign_body" title="Foreign body">foreign body</a>, aspirated food bolus);</li>

<li>infections (e.g., <a href="Epiglottitis" title="Epiglottitis">epiglottitis</a>, <a href="Retropharyngeal_abscess" title="Retropharyngeal abscess">retropharyngeal abscess</a>, <a href="Croup" title="Croup">croup</a>);</li>

<li>subglottic <a href="Stenosis" title="Stenosis">stenosis</a> (e.g., following prolonged intubation or congenital);</li>

<li>airway edema (e.g., following instrumentation of the airway, <a href="Tracheal_intubation" title="Tracheal intubation">tracheal intubation</a>, drug side effect, <a href="Allergic_reaction" class="mw-redirect" title="Allergic reaction">allergic reaction</a>);</li>

<li><a href="Laryngospasm" title="Laryngospasm">laryngospasm</a> (from aspiration, <a href="GERD" class="mw-redirect" title="GERD">GERD</a>, or complication of <a href="Anesthesia" title="Anesthesia">anesthesia</a>)</li>

<li>subglottic <a href="Hemangioma" title="Hemangioma">hemangioma</a> (rare);</li>

<li><a href="Vascular_rings" class="mw-redirect" title="Vascular rings">vascular rings</a> compressing the trachea;</li>

<li>thyroiditis such as <a href="Riedel's_thyroiditis" title="Riedel's thyroiditis">Riedel's thyroiditis</a>;</li>

<li><a href="Vocal_cord" class="mw-redirect" title="Vocal cord">vocal cord</a> palsy;</li>

<li><a href="Tracheomalacia" title="Tracheomalacia">tracheomalacia</a> or tracheobronchomalacia (e.g., collapsed trachea).</li>

<li><a href="Congenital" class="mw-redirect" title="Congenital">congenital</a> anomalies of the airway are present in 87% of all cases of stridor in infants and children.<sup id="cite_ref-pmid7436240_1-0" class="reference"><a href="#cite_note-pmid7436240-1"><span class="cite-bracket">[</span>1<span class="cite-bracket">]</span></a></sup></li>

<li><a href="Vasculitis" title="Vasculitis">vasculitis</a>.</li>

<li>infectious mononucleosis</li>

<li>peritonsillar abscess</li>

<li>Laryngeal edema is a common cause of stridor post extubation (occurring from pressure of the endotracheal tube on the mucosa as a result of endotracheal tube that is too large (e.g. pediatrics), cuff over inflation, and prolonged intubation times.);<sup id="cite_ref-2" class="reference"><a href="#cite_note-2"><span class="cite-bracket">[</span>2<span class="cite-bracket">]</span></a></sup></li>

<li>tumor (e.g., laryngeal papillomatosis, <a href="Squamous_cell_carcinoma" class="mw-redirect" title="Squamous cell carcinoma">squamous cell carcinoma</a> of larynx, trachea or esophagus);</li>

<li><a href="Acute_lymphoblastic_leukemia" title="Acute lymphoblastic leukemia">ALL</a> (T-cell ALL can present with mediastinal mass that compresses the trachea and causes inspiratory stridor)</li></ul>

<div class="mw-heading mw-heading2"><h2 id="Diagnosis">Diagnosis</h2></div>

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

</p><p>Chest and neck <a href="X-rays" class="mw-redirect" title="X-rays">x-rays</a>, <a href="Bronchoscopy" title="Bronchoscopy">bronchoscopy</a>, <a href="CT-scans" class="mw-redirect" title="CT-scans">CT-scans</a>, and/or <a href="MRIs" class="mw-redirect" title="MRIs">MRIs</a> may reveal structural pathology.

</p><p>Flexible fiberoptic <a href="Bronchoscopy" title="Bronchoscopy">bronchoscopy</a> can also be very helpful, especially in assessing vocal cord function or in looking for signs of compression or infection.

</p>

<div class="mw-heading mw-heading2"><h2 id="Treatments">Treatments</h2></div>

<p>The first issue of clinical concern in the setting of stridor is whether or not <a href="Tracheal_intubation" title="Tracheal intubation">tracheal intubation</a> or <a href="Tracheostomy" class="mw-redirect" title="Tracheostomy">tracheostomy</a> 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:

</p>

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

<li>Use of <a href="Nebulizer" title="Nebulizer">nebulized</a> racemic adrenaline <a href="Epinephrine" class="mw-redirect" title="Epinephrine">epinephrine</a> (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 <a href="Codeine" title="Codeine">Codeine</a> 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].)</li>

<li>Use of <a href="Dexamethasone" title="Dexamethasone">dexamethasone</a> (<a href="Decadron" class="mw-redirect" title="Decadron">Decadron</a>) 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.</li>

<li>Use of inhaled <a href="Heliox" title="Heliox">Heliox</a> (70% <a href="Helium" title="Helium">helium</a>, 30% <a href="Oxygen" title="Oxygen">oxygen</a>); the effect is almost instantaneous. Helium, being a less dense gas than nitrogen, reduces turbulent flow through the airways. Always ensure an open airway.</li></ul>

<p>In obese patients elevation of the <a href="Panniculus" title="Panniculus">panniculus</a> has shown to relieve symptoms by 80%.

</p>

<div class="mw-heading mw-heading2"><h2 id="References">References</h2></div>

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</style><cite id="CITEREFHolinger_LD1980" class="citation journal cs1">Holinger LD (1980). "Etiology of stridor in the neonate, infant and child". <i>Ann. Otol. Rhinol. Laryngol</i>. <b>89</b> (5 Pt 1): <span class="nowrap">397–</span>400. <a href="Doi_(identifier)" class="mw-redirect" title="Doi (identifier)">doi</a>:<a rel="nofollow" class="external text" href="https://doi.org/10.1177%2F000348948008900502">10.1177/000348948008900502</a>. <a href="PMID_(identifier)" class="mw-redirect" title="PMID (identifier)">PMID</a> <a rel="nofollow" class="external text" href="https://pubmed.ncbi.nlm.nih.gov/7436240">7436240</a>. <a href="S2CID_(identifier)" class="mw-redirect" title="S2CID (identifier)">S2CID</a> <a rel="nofollow" class="external text" href="https://api.semanticscholar.org/CorpusID:20514618">20514618</a>.</cite></span>

</li>

<li id="cite_note-2"><span class="mw-cite-backlink"><b><a href="#cite_ref-2">^</a></b></span> <span class="reference-text">Wittekamp, Bastiaan HJ. Clinical review: Post-extubation laryngeal edema and extubation failure in critically ill adult patients. Crit Care. 2009; 13(6): 233.</span>

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<div class="mw-heading mw-heading2"><h2 id="External_links">External links</h2></div>

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<div class="side-box-text plainlist">Look up <i><b><a href="https://en.wiktionary.org/wiki/Special:Search/stridor" class="extiw external" title="wiktionary:Special:Search/stridor">stridor</a></b></i> in Wiktionary, the free dictionary.</div></div>

</div>

<ul><li><a rel="nofollow" class="external text" href="http://respwiki.com/Breath_sounds">Audio Breath Sounds</a> <a rel="nofollow" class="external text" href="https://web.archive.org/web/20201215121532/http://respwiki.com/Breath_sounds">Archived</a> 2020-12-15 at the <a href="Wayback_Machine" title="Wayback Machine">Wayback Machine</a>—Multiple case studies with audio files of lung sounds.</li>

<li><i><a rel="nofollow" class="external text" href="http://www.emedicine.com/ped/topic2159.htm#">Stridor</a></i> at <a href="EMedicine" title="EMedicine">eMedicine</a></li>

<li><i><a rel="nofollow" class="external text" href="http://www.emedicine.com/ped/topic2624.htm#">Congenital stridor</a></i> at <a href="EMedicine" title="EMedicine">eMedicine</a></li>

<li><i><a href="MedlinePlus" title="MedlinePlus">MedlinePlus Encyclopedia</a></i>: <a rel="nofollow" class="external text" href="https://medlineplus.gov/ency/article/003074.htm">Breathing sounds—abnormal (stridor)</a></li>

<li><a href="Diseases_Database" title="Diseases Database">Diseases Database</a> (DDB): <a rel="nofollow" class="external text" href="http://www.diseasesdatabase.com/ddb27190.htm">27190</a></li>

<li><a rel="nofollow" class="external text" href="http://www.rale.ca/Stridor.htm">Stridor sounds at R.A.L.E. Lung Sounds</a></li></ul>

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</style><div id="Signs_and_symptoms_relating_to_the_respiratory_system111" style="font-size:114%;margin:0 4em"><a href="Signs_and_symptoms" title="Signs and symptoms">Signs and symptoms</a> relating to the <a href="Respiratory_system" title="Respiratory system">respiratory system</a></div></th></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="Auscultation" title="Auscultation">Auscultation</a></th><td class="navbox-list-with-group navbox-list navbox-odd hlist" style="width:100%;padding:0"><div style="padding:0 0.25em">

<ul><li><a href="Stethoscope" title="Stethoscope">Stethoscope</a></li>

<li><a href="Respiratory_sounds" title="Respiratory sounds">Respiratory sounds</a>

<ul>

<li><a href="Wheeze" title="Wheeze">Wheeze</a></li>

<li><a href="Crackles" title="Crackles">Crackles</a></li>

<li><a href="Rhonchi" class="mw-redirect" title="Rhonchi">Rhonchi</a></li>

<li><a href="Stertor" title="Stertor">Stertor</a></li>

<li><a href="Squawk_(sound)" title="Squawk (sound)">Squawk</a></li>

<li><a href="Pleural_friction_rub" title="Pleural friction rub">Pleural friction rub</a></li>

<li><a href="Fremitus" title="Fremitus">Fremitus</a></li>

<li><a href="Bronchophony" title="Bronchophony">Bronchophony</a></li>

<li><a href="Death_rattle" title="Death rattle">Death rattle</a></li></ul></li>

<li>Elicited findings

<ul><li><a href="Percussion_(medicine)" title="Percussion (medicine)">Percussion</a></li>

<li><a href="Pectoriloquy" title="Pectoriloquy">Pectoriloquy</a></li>

<li><a href="Whispered_pectoriloquy" title="Whispered pectoriloquy">Whispered pectoriloquy</a></li>

<li><a href="Egophony" title="Egophony">Egophony</a></li></ul></li></ul>

</div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="Breathing" title="Breathing">Breathing</a></th><td class="navbox-list-with-group navbox-list navbox-odd hlist" style="width:100%;padding:0"><div style="padding:0 0.25em"></div><table class="nowraplinks navbox-subgroup" style="border-spacing:0"><tbody><tr><th scope="row" class="navbox-group" style="width:1%">Rate</th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em">

<ul><li><a href="Apnea" title="Apnea">Apnea</a>

<ul><li><a href="Apnea_of_prematurity" title="Apnea of prematurity">Prematurity</a></li>

<li><a href="Sleep_apnea" title="Sleep apnea">Sleep</a></li></ul></li>

<li><a href="Shortness_of_breath" title="Shortness of breath">Dyspnea</a></li>

<li><a href="Hyperventilation" title="Hyperventilation">Hyperventilation</a></li>

<li><a href="Hypoventilation" title="Hypoventilation">Hypoventilation</a></li>

<li><a href="Hyperpnea" title="Hyperpnea">Hyperpnea</a></li>

<li><a href="Tachypnea" title="Tachypnea">Tachypnea</a></li>

<li><a href="Hypopnea" title="Hypopnea">Hypopnea</a></li>

<li><a href="Bradypnea" title="Bradypnea">Bradypnea</a></li></ul>

</div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">Pattern</th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em">

<ul><li><a href="Agonal_respiration" title="Agonal respiration">Agonal respiration</a></li>

<li><a href="Biot's_respiration" class="mw-redirect" title="Biot's respiration">Biot's respiration</a></li>

<li><a href="Cheyne%E2%80%93Stokes_respiration" title="Cheyne–Stokes respiration">Cheyne–Stokes respiration</a></li>

<li><a href="Kussmaul_breathing" title="Kussmaul breathing">Kussmaul breathing</a></li>

<li><a href="Ataxic_respiration" title="Ataxic respiration">Ataxic respiration</a></li></ul>

</div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">Other</th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em">

<ul><li><a href="Respiratory_distress" class="mw-redirect" title="Respiratory distress">Respiratory distress</a></li>

<li><a href="Respiratory_arrest" title="Respiratory arrest">Respiratory arrest</a></li>

<li><a href="Orthopnea" title="Orthopnea">Orthopnea</a>/<a href="Platypnea" title="Platypnea">Platypnea</a></li>

<li><a href="Trepopnea" title="Trepopnea">Trepopnea</a></li>

<li><a href="Aerophagia" title="Aerophagia">Aerophagia</a></li>

<li><a href="Asphyxia" title="Asphyxia">Asphyxia</a></li>

<li><a href="Breath-holding_spell" title="Breath-holding spell">Breath holding</a></li>

<li><a href="Mouth_breathing" title="Mouth breathing">Mouth breathing</a></li>

<li><a href="Snoring" title="Snoring">Snoring</a></li></ul>

</div></td></tr></tbody></table><div></div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">Speech and voice</th><td class="navbox-list-with-group navbox-list navbox-odd hlist" style="width:100%;padding:0"><div style="padding:0 0.25em">

<ul><li><a href="Aphonia" title="Aphonia">Aphonia</a>

<ul><li><a href="Muteness" title="Muteness">Muteness</a></li></ul></li>

<li><a href="Dysphonia" class="mw-redirect" title="Dysphonia">Dysphonia</a></li>

<li><a href="Hypophonia" title="Hypophonia">Hypophonia</a></li></ul>

</div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">Other</th><td class="navbox-list-with-group navbox-list navbox-even hlist" style="width:100%;padding:0"><div style="padding:0 0.25em">

<ul><li><a href="Chest_pain" title="Chest pain">Chest pain</a>

<ul><li><a href="Chest_pain_in_children" title="Chest pain in children">In children</a></li>

<li><a href="Precordial_catch_syndrome" title="Precordial catch syndrome">Precordial catch syndrome</a></li>

<li><a href="Pleurisy" title="Pleurisy">Pleurisy</a></li></ul></li>

<li><a href="Nail_clubbing" title="Nail clubbing">Nail clubbing</a></li>

<li><a href="Cyanosis" title="Cyanosis">Cyanosis</a></li>

<li><a href="Cough" title="Cough">Cough</a></li>

<li><a href="Sputum" title="Sputum">Sputum</a></li>

<li><a href="Hemoptysis" title="Hemoptysis">Hemoptysis</a></li>

<li><a href="Epistaxis" class="mw-redirect" title="Epistaxis">Epistaxis</a></li>

<li><a href="Silhouette_sign" title="Silhouette sign">Silhouette sign</a></li>

<li><a href="Post-nasal_drip" title="Post-nasal drip">Post-nasal drip</a></li>

<li><a href="Hiccup" title="Hiccup">Hiccup</a></li>

<ul><li><a href="Hoover's_sign_(pulmonary)" title="Hoover's sign (pulmonary)">Hoover's sign</a></li></ul></li>

<li><i><a href="Asthma" title="Asthma">asthma</a></i>

<ul><li><a href="Curschmann's_spirals" title="Curschmann's spirals">Curschmann's spirals</a></li>

<li><a href="Charcot%E2%80%93Leyden_crystals" title="Charcot–Leyden crystals">Charcot–Leyden crystals</a></li></ul></li>

<li><i><a href="Bronchitis#Chronic_bronchitis" title="Bronchitis">chronic bronchitis</a></i>

<ul><li><a href="Reid_index" title="Reid index">Reid index</a></li></ul></li>

<li><i><a href="Sarcoidosis" title="Sarcoidosis">sarcoidosis</a></i>

<ul><li><a href="Kveim_test" title="Kveim test">Kveim test</a></li></ul></li>

<li><i><a href="Pulmonary_embolism" title="Pulmonary embolism">pulmonary embolism</a></i>

<ul><li><a href="Hampton_hump" title="Hampton hump">Hampton hump</a></li>

<li><a href="Westermark_sign" title="Westermark sign">Westermark sign</a></li></ul></li>

<li><i><a href="Pulmonary_edema" title="Pulmonary edema">pulmonary edema</a></i>

<ul><li><a href="Kerley_lines" title="Kerley lines">Kerley lines</a></li></ul></li>

<li><a href="Hamman's_sign" title="Hamman's sign">Hamman's sign</a></li>

<li><a href="Golden_S_sign" title="Golden S sign">Golden S sign</a></li></ul>

</div></td></tr></tbody></table></div></div><div><div class="zim-footer">

This article is issued from <a class="external text" title="Last edited on 2025-05-16" href="https://en.wikipedia.org/wiki/?title=Stridor&oldid=1290637283">Wikipedia</a>. The text is available under <a class="external text" href="https://creativecommons.org/licenses/by-sa/4.0/deed.en">Creative Commons Attribution-Share Alike 4.0</a> unless otherwise noted. Additional terms may apply for the media files.

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