is a high pitched sound heard on
Inspiration resulting from turbulent gas flow in the upper airway. It is usually indicative of serious
Airway obstruction from severe conditions such as
Epiglottitis . Stridor is indicative of a potential
Medical Emergency and should always command attention. Wherever possible, attempts should be made to immediately establish the cause of the stridor (e.g., foreign body, vocal cord edema, tracheal compression by tumor, functional laryngeal dyskinesia, etc.)
The first issue of clinical concern in the setting of stridor is whether or not
Tracheal Intubation is immediately necessary. 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 of the bed for optimum conditions (e.g., 45 - 90 degrees)
- Use of Dexamethasone ( 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 need for dexamethasone to work fully.
Stridor has many different potential causes. It may occur as a result of:
- foreign bodies (e.g., Aspirated Peanut , aspirated wire),
- tumor formation (e.g., laryngeal papillomatosis, Squamous Cell Carcinoma ),
- infections (e.g., Epiglottitis , retropharyngeal abscess, Croup ),
- subglottic Stenosis (e.g., following prolonged intubation),
- airway edema (e.g., following instrumentation of the airway intubation),
- as well as a result of Laryngomalacia (the most common congenital cause of stridor),
- subglottic Hemangioma (rare),
- and Vascular Rings compressing the trachea.
- Abnormalities of vocal cord function can also be responsible.
- Congenital anomalies of the airway are present in 87% of all cases of stridor in infants and children {Link without Title} .
Stridor is usually diagnosed on the basis of history and physical examination, with a view to revealing the underlying problem or condition.
Chest and neck
X-rays ,
CT-scans , and / or
MRIs may reveal structural pathology.
Flexible fiberoptic
Bronchoscopy can also be very helpful, especially in assessing vocal cord function of in looking for signs of compression or infection.
- 1. Holinger LD: Etiology of stridor, Ann Otol Rhinol Laryngol 1980; 89:397–400.
