Stridor - Revision history

Danbot: Add verified PubMed reference (PMID 25213283)

2026-03-22T10:43:35Z

Add verified PubMed reference (PMID 25213283)

← Older revision		Revision as of 10:43, 22 March 2026
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	{{AdultPage\|stridor (peds)}}		{{AdultPage\|stridor (peds)}}
	==Background==		==Background==
	*Stridor refers to harsh upper airway sounds caused by turbulent airflow through a narrowed airway		*Stridor refers to harsh upper airway sounds caused by turbulent airflow through a narrowed airway<ref>Ida JB, Thompson DM. Pediatric stridor. Otolaryngol Clin North Am. 2014 Oct;47(5):795-819. PMID 25213283</ref>
	*Classically inspiratory, indicating extrathoracic obstruction		*Classically inspiratory, indicating extrathoracic obstruction
	*A true airway emergency — rapidly assess for need for definitive airway management		*A true airway emergency — rapidly assess for need for definitive airway management

Danbot: Strip excess bold

2026-03-22T09:35:05Z

Strip excess bold

Danbot: Expanded with EM-focused content: phase-based assessment, differential, evaluation strategy, condition-specific management, disposition

2026-03-20T23:25:36Z

Expanded with EM-focused content: phase-based assessment, differential, evaluation strategy, condition-specific management, disposition

← Older revision		Revision as of 23:25, 20 March 2026
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	{{AdultPage\|stridor (peds)}}		{{AdultPage\|stridor (peds)}}
	==Background==		==Background==
	*Stridor refers to harsh upper airway sounds, ~~classically inspiratory~~		*Stridor refers to harsh upper airway sounds caused by turbulent airflow through a narrowed airway
			*Classically inspiratory, indicating extrathoracic obstruction
			*A true airway emergency — rapidly assess for need for definitive airway management
			*In adults, the differential differs significantly from pediatrics due to larger airway caliber
			*Most common adult causes: [[anaphylaxis]], foreign body, [[angioedema]], infection (peritonsillar/retropharyngeal abscess, epiglottitis), post-extubation edema, and malignancy

	==Clinical Features==		==Clinical Features==
	*Inspiratory stridor		===Phase of Respiration===
	**~~Suggestive of extrathoracic obstruction (~~Pressure<sub>trach</sub> < Pressure<sub>atm</sub>)		*'''Inspiratory stridor''': extrathoracic obstruction (supraglottic or glottic level)
	**[[~~Aspirated foreign body\|foreign body~~]], [[~~epiglottitis~~]]		**Pressure<sub>trach</sub> < Pressure<sub>atm</sub> causes dynamic collapse
	*Expiratory stridor vs. [[wheezing]]		**Examples: [[epiglottitis]], [[angioedema]], foreign body, laryngeal mass
	**~~Suggestive of intrathoracic obstruction (~~Pressure<sub>trach</sub> < Pressure<sub>pleura</sub>)		*'''Expiratory stridor''' (vs. [[wheezing]]): intrathoracic obstruction (subglottic/tracheal level)
	**[[~~Asthma~~]]		**Pressure<sub>trach</sub> < Pressure<sub>pleura</sub>
			**Examples: tracheal mass, goiter, tracheomalacia
			*'''Biphasic stridor''': fixed obstruction (critical narrowing at glottis or subglottis)
			**Examples: subglottic stenosis, bilateral vocal cord paralysis, large foreign body

			===Associated Features===
			*Drooling, dysphagia, muffled voice (supraglottic process)
			*Hoarseness (glottic or recurrent laryngeal nerve involvement)
			*Fever (infectious etiology)
			*Facial/lip/tongue swelling ([[angioedema]], [[anaphylaxis]])
			*History of intubation, neck surgery, or radiation (subglottic stenosis, recurrent laryngeal nerve injury)
			*Preceding choking event (foreign body)

	==Differential Diagnosis==		==Differential Diagnosis==
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	==Evaluation==		==Evaluation==
	*Assess airway		===Immediate===
	**~~If unstable~~, ~~see [[Difficult Airway Algorithm]]~~, ~~[[Intubation]] and consider surgical intervention/consultation~~		*Assess airway stability — if in extremis, proceed directly to airway management
	**~~If stable, consider imaging~~ or direct visualization ~~of larynx with fiberoptic scope or video laryngoscope~~ [[~~GEMC:Airway Procedures~~]]		*Pulse oximetry (may be normal until late stages)
	*~~CT of neck~~ if ~~mass/infection~~ suspected		*Allow patient to maintain position of comfort
			*Do NOT agitate the patient if concern for supraglottic infection (epiglottitis)

			===Workup===
			*'''Stable patient:'''
			**Lateral soft tissue neck radiograph (thumbprint sign in epiglottitis, retropharyngeal widening)
			**CT neck with contrast if mass, abscess, or deep space infection suspected
			**Nasopharyngoscopy or fiberoptic laryngoscopy for direct visualization (if available and safe)
			*'''Unstable patient:'''
			**Defer imaging — proceed to airway management
			**Consider calling anesthesia, ENT for surgical airway backup

			===Laboratory===
			*Generally not helpful acutely
			*Consider [[CBC]], blood cultures if infectious etiology suspected
			*[[Tryptase]] if [[anaphylaxis]] suspected

	==Management==		==Management==
	*~~Treat underlying cause~~		===Airway Management===
			*Prepare for [[difficult airway]] — have backup equipment ready including surgical airway kit
			*[[Intubation]] with a smaller-than-expected endotracheal tube (due to narrowed airway)
			*Consider awake fiberoptic intubation if expertise available
			*Surgical airway ([[cricothyrotomy]]) if unable to intubate/ventilate
			*Call for help early (anesthesia, ENT)

			===Condition-Specific===
			*'''[[Anaphylaxis]]''': [[epinephrine]] IM 0.3-0.5mg, repeat q5-15min; adjuncts per [[anaphylaxis]] protocol
			*'''[[Angioedema]]''': distinguish allergic vs. [[ACE inhibitor]]-induced vs. hereditary
			**Allergic: [[epinephrine]], [[antihistamines]], [[corticosteroids]]
			**[[ACE inhibitor]]-induced: [[epinephrine]] if severe, consider icatibant or C1-esterase inhibitor concentrate
			**[[Hereditary angioedema]]: C1-esterase inhibitor concentrate, icatibant, or ecallantide
			*'''[[Epiglottitis]]''': IV antibiotics (ceftriaxone + vancomycin), airway management in OR if possible
			*'''Peritonsillar/retropharyngeal abscess''': IV antibiotics, surgical drainage, ENT consultation
			*'''Foreign body''': direct laryngoscopy or bronchoscopy for removal
			*'''Post-extubation stridor''': racemic [[epinephrine]] nebulized, IV [[dexamethasone]], consider [[Heliox]]
			*'''Malignancy''': ENT/oncology consultation, [[dexamethasone]] for tumor-related edema

	==Disposition==		==Disposition==
	*~~Based on underlying cause~~		*All patients with stridor should be closely monitored
			*Most require admission for airway observation
			*ICU admission for: tenuous airway, requiring repeated treatments, post-intubation
			*Discharge is rare — only if complete resolution of mild post-procedural or allergic stridor after observed treatment and monitoring

	==See Also==		==See Also==
	*[[Stridor (Peds)]]		*[[Stridor (Peds)]]
			*[[Difficult Airway Algorithm]]
			*[[Anaphylaxis]]
			*[[Angioedema]]
			*[[Epiglottitis]]

	==External Links==		==External Links==


	==References==		==References==
	<references/>		<references/>

	~~[[Category:Critical Care]]~~
	[[Category:ENT]]		[[Category:ENT]]
	[[Category:Symptoms]]		[[Category:Symptoms]]
			[[Category:Pulmonology]]

Ostermayer at 17:55, 16 January 2026

2026-01-16T17:55:12Z

← Older revision		Revision as of 17:55, 16 January 2026
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	{{~~Adult top}} [[~~stridor (peds)~~]].''~~		{{AdultPage\|stridor (peds)}}
	==Background==		==Background==
	*Stridor refers to harsh upper airway sounds, classically inspiratory		*Stridor refers to harsh upper airway sounds, classically inspiratory

Rossdonaldson1: /* Clinical Features */

2020-07-01T16:48:29Z

Clinical Features

← Older revision		Revision as of 16:48, 1 July 2020
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	*Inspiratory stridor		*Inspiratory stridor
	**Suggestive of extrathoracic obstruction (Pressure<sub>trach</sub> < Pressure<sub>atm</sub>)		**Suggestive of extrathoracic obstruction (Pressure<sub>trach</sub> < Pressure<sub>atm</sub>)
	**[[~~Croup]], metapneumovirus, [[aspirated~~ foreign body\|foreign body]], [[epiglottitis]]		**[[Aspirated foreign body\|foreign body]], [[epiglottitis]]
	*Expiratory stridor vs. [[wheezing]]		*Expiratory stridor vs. [[wheezing]]
	**Suggestive of intrathoracic obstruction (Pressure<sub>trach</sub> < Pressure<sub>pleura</sub>)		**Suggestive of intrathoracic obstruction (Pressure<sub>trach</sub> < Pressure<sub>pleura</sub>)
	**[[Asthma~~]], [[bronchiolitis~~]]		**[[Asthma]]

	==Differential Diagnosis==		==Differential Diagnosis==

Rossdonaldson1: /* Differential Diagnosis */

2020-07-01T16:46:58Z

Differential Diagnosis

← Older revision		Revision as of 16:46, 1 July 2020
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	==Differential Diagnosis==		==Differential Diagnosis==
	{{Stridor DDx}}		{{Stridor DDx}}
	~~{{Pediatric stridor DDX}}~~

	==Evaluation==		==Evaluation==

Rossdonaldson1 at 16:25, 1 July 2020

2020-07-01T16:25:22Z

← Older revision		Revision as of 16:25, 1 July 2020
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			{{Adult top}} [[stridor (peds)]].''
	==Background==		==Background==
	*Stridor refers to harsh upper airway sounds, classically inspiratory		*Stridor refers to harsh upper airway sounds, classically inspiratory

ClaireLewis: /* Clinical Features */

2019-09-27T16:01:37Z

Clinical Features

← Older revision		Revision as of 16:01, 27 September 2019
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	**Suggestive of extrathoracic obstruction (Pressure<sub>trach</sub> < Pressure<sub>atm</sub>)		**Suggestive of extrathoracic obstruction (Pressure<sub>trach</sub> < Pressure<sub>atm</sub>)
	**[[Croup]], metapneumovirus, [[aspirated foreign body\|foreign body]], [[epiglottitis]]		**[[Croup]], metapneumovirus, [[aspirated foreign body\|foreign body]], [[epiglottitis]]
	*Expiratory stridor vs. wheezing		*Expiratory stridor vs. [[wheezing]]
	**Suggestive of intrathoracic obstruction (Pressure<sub>trach</sub> < Pressure<sub>pleura</sub>)		**Suggestive of intrathoracic obstruction (Pressure<sub>trach</sub> < Pressure<sub>pleura</sub>)
	**Asthma, bronchiolitis		**[[Asthma]], [[bronchiolitis]]

	==Differential Diagnosis==		==Differential Diagnosis==

ClaireLewis at 19:06, 14 September 2019

2019-09-14T19:06:12Z

← Older revision		Revision as of 19:06, 14 September 2019
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	*Inspiratory stridor		*Inspiratory stridor
	**Suggestive of extrathoracic obstruction (Pressure<sub>trach</sub> < Pressure<sub>atm</sub>)		**Suggestive of extrathoracic obstruction (Pressure<sub>trach</sub> < Pressure<sub>atm</sub>)
	**Croup, metapneumovirus, FB, epiglottitis		**[[Croup]], metapneumovirus, [[aspirated foreign body\|foreign body]], [[epiglottitis]]
	*Expiratory stridor vs. wheezing		*Expiratory stridor vs. wheezing
	**Suggestive of intrathoracic obstruction (Pressure<sub>trach</sub> < Pressure<sub>pleura</sub>)		**Suggestive of intrathoracic obstruction (Pressure<sub>trach</sub> < Pressure<sub>pleura</sub>)
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	==Differential Diagnosis==		==Differential Diagnosis==
	{{Stridor DDx}}		{{Stridor DDx}}
			{{Pediatric stridor DDX}}

	==Evaluation==		==Evaluation==

Mholtz at 22:20, 31 December 2016

2016-12-31T22:20:07Z

← Older revision		Revision as of 22:20, 31 December 2016
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	==Background==		==Background==
	*Stridor refers to harsh upper airway sounds		*Stridor refers to harsh upper airway sounds, classically inspiratory

	==Clinical Features==		==Clinical Features==
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	==Evaluation==		==Evaluation==
	*Assess ~~stability of~~ airway		*Assess airway
	**If unstable, see [[Difficult Airway Algorithm]], ~~see~~ [[Intubation]] and consider surgical intervention/consultation		**If unstable, see [[Difficult Airway Algorithm]], [[Intubation]] and consider surgical intervention/consultation
	**If stable consider imaging with video laryngoscope [[GEMC:Airway Procedures]]		**If stable, consider imaging or direct visualization of larynx with fiberoptic scope or video laryngoscope [[GEMC:Airway Procedures]]
	***CT of neck ~~can be considered~~ if mass/infection suspected ~~but not dynamic like laryngoscope~~		*CT of neck if mass/infection suspected

	==Management==		==Management==
	*~~Treatment depends on pathologic~~ cause		*Treat underlying cause

	==Disposition==		==Disposition==
			*Based on underlying cause

	==See Also==		==See Also==
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	==External Links==		==External Links==


	==References==		==References==

← Older revision		Revision as of 09:35, 22 March 2026
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	==Clinical Features==		==Clinical Features==
	===Phase of Respiration===		===Phase of Respiration===
	*~~'''~~Inspiratory stridor~~'''~~: extrathoracic obstruction (supraglottic or glottic level)		*Inspiratory stridor: extrathoracic obstruction (supraglottic or glottic level)
	**Pressure<sub>trach</sub> < Pressure<sub>atm</sub> causes dynamic collapse		**Pressure<sub>trach</sub> < Pressure<sub>atm</sub> causes dynamic collapse
	**Examples: [[epiglottitis]], [[angioedema]], foreign body, laryngeal mass		**Examples: [[epiglottitis]], [[angioedema]], foreign body, laryngeal mass
	*~~'''~~Expiratory stridor~~'''~~ (vs. [[wheezing]]): intrathoracic obstruction (subglottic/tracheal level)		*Expiratory stridor (vs. [[wheezing]]): intrathoracic obstruction (subglottic/tracheal level)
	**Pressure<sub>trach</sub> < Pressure<sub>pleura</sub>		**Pressure<sub>trach</sub> < Pressure<sub>pleura</sub>
	**Examples: tracheal mass, goiter, tracheomalacia		**Examples: tracheal mass, goiter, tracheomalacia
	*~~'''~~Biphasic stridor~~'''~~: fixed obstruction (critical narrowing at glottis or subglottis)		*Biphasic stridor: fixed obstruction (critical narrowing at glottis or subglottis)
	**Examples: subglottic stenosis, bilateral vocal cord paralysis, large foreign body		**Examples: subglottic stenosis, bilateral vocal cord paralysis, large foreign body

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	===Workup===		===Workup===
	*~~'''~~Stable patient:~~'''~~		*Stable patient:
	**Lateral soft tissue neck radiograph (thumbprint sign in epiglottitis, retropharyngeal widening)		**Lateral soft tissue neck radiograph (thumbprint sign in epiglottitis, retropharyngeal widening)
	**CT neck with contrast if mass, abscess, or deep space infection suspected		**CT neck with contrast if mass, abscess, or deep space infection suspected
	**Nasopharyngoscopy or fiberoptic laryngoscopy for direct visualization (if available and safe)		**Nasopharyngoscopy or fiberoptic laryngoscopy for direct visualization (if available and safe)
	*~~'''~~Unstable patient:~~'''~~		*Unstable patient:
	**Defer imaging — proceed to airway management		**Defer imaging — proceed to airway management
	**Consider calling anesthesia, ENT for surgical airway backup		**Consider calling anesthesia, ENT for surgical airway backup
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	===Condition-Specific===		===Condition-Specific===
	*'''[[Anaphylaxis]]''': [[epinephrine]] IM 0.3-0.5mg, repeat q5-15min; adjuncts per [[anaphylaxis]] protocol		*'''[[Anaphylaxis]]''': [[epinephrine]] IM 0.3-0.5mg, repeat q5-15min; adjuncts per [[anaphylaxis]] protocol
	*~~'''~~[[Angioedema]]~~'''~~: distinguish allergic vs. [[ACE inhibitor]]-induced vs. hereditary		*[[Angioedema]]: distinguish allergic vs. [[ACE inhibitor]]-induced vs. hereditary
	**Allergic: [[epinephrine]], [[antihistamines]], [[corticosteroids]]		**Allergic: [[epinephrine]], [[antihistamines]], [[corticosteroids]]
	**[[ACE inhibitor]]-induced: [[epinephrine]] if severe, consider icatibant or C1-esterase inhibitor concentrate		**[[ACE inhibitor]]-induced: [[epinephrine]] if severe, consider icatibant or C1-esterase inhibitor concentrate
	**[[Hereditary angioedema]]: C1-esterase inhibitor concentrate, icatibant, or ecallantide		**[[Hereditary angioedema]]: C1-esterase inhibitor concentrate, icatibant, or ecallantide
	*~~'''~~[[Epiglottitis]]~~'''~~: IV antibiotics (ceftriaxone + vancomycin), airway management in OR if possible		*[[Epiglottitis]]: IV antibiotics (ceftriaxone + vancomycin), airway management in OR if possible
	*~~'''~~Peritonsillar/retropharyngeal abscess~~'''~~: IV antibiotics, surgical drainage, ENT consultation		*Peritonsillar/retropharyngeal abscess: IV antibiotics, surgical drainage, ENT consultation
	*~~'''~~Foreign body~~'''~~: direct laryngoscopy or bronchoscopy for removal		*Foreign body: direct laryngoscopy or bronchoscopy for removal
	*~~'''~~Post-extubation stridor~~'''~~: racemic [[epinephrine]] nebulized, IV [[dexamethasone]], consider [[Heliox]]		*Post-extubation stridor: racemic [[epinephrine]] nebulized, IV [[dexamethasone]], consider [[Heliox]]
	*~~'''~~Malignancy~~'''~~: ENT/oncology consultation, [[dexamethasone]] for tumor-related edema		*Malignancy: ENT/oncology consultation, [[dexamethasone]] for tumor-related edema

	==Disposition==		==Disposition==