Stridor

This page is for adult patients. For pediatric patients, see: stridor (peds).

Background

• Stridor refers to harsh upper airway sounds, classically inspiratory

Clinical Features

• Inspiratory stridor
  • Suggestive of extrathoracic obstruction (Pressure_trach < Pressure_atm)
  • foreign body, epiglottitis
• Expiratory stridor vs. wheezing
  • Suggestive of intrathoracic obstruction (Pressure_trach < Pressure_pleura)
  • Asthma

Differential Diagnosis

Stridor

Trauma

• Larynx fracture
• Tracheobronchial tear/injury
• Thyroid gland injury/trauma
• Tracheal injury
• Electromagnetic or radiation exposure
• Burns, inhalation injury

Infectious Disorders

• Bacterial tracheitis
• Diphtheria
• Tetanus
• Tracheobronchial tuberculosis
• Poliomyelitis, paralytic, bulbar, or acute
• Fungal laryngitis

Abscesses

• Retropharyngeal abscess
• Epiglottitis, acute
• Peritonsillar abscess
• Laryngotracheobronchitis (croup)
• Retropharyngeal abscess

Neoplastic Disorders

• Neoplasms/tumors

Allergic and Auto-Immune Disorders

• Spasmodic/tracheobronchitis
• Angioedema/Angioneurotic edema

Metabolic, Storage Disorders

• Cerebral Gaucher's of infants (acute)
• Tracheobronchial amyloidosis

Biochemical Disorders

• Tetany

Congenital, Developmental Disorders

• Angioedema/Angioneurotic edema, hereditary

Psychiatric Disorders

• Somatization disorder

Anatomical or Mechanical

• Foreign body aspiration
• Acute gastric acid/aspiration syndrome
• Airway obstruction
• Neck compartment hemorrhage/hematoma
• Paradoxical vocal fold motion

Vegetative, Autonomic, Endocrine Disorders

• Esophageal free reflux/GERD syndrome
• Laryngospasm, acute
  • Bilateral vocal cord paralysis
• Hypoparathyroidism

Poisoning

• Smoke inhalation
• Chemical burn/esophagus

Chronic Pediatric Conditions

• Laryngotracheomalacia
• Subglottic stenosis or prior intubation
• Vascular ring (double aortic arch)
• Vocal cord dysfunction/paroxysmal vocal fold movement

Evaluation

• Assess airway
  • If unstable, see Difficult Airway Algorithm, Intubation and consider surgical intervention/consultation
  • If stable, consider imaging or direct visualization of larynx with fiberoptic scope or video laryngoscope GEMC:Airway Procedures
• CT of neck if mass/infection suspected

Management

• Treat underlying cause

Disposition

• Based on underlying cause

See Also

• Stridor (Peds)