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{{short description|High-pitched breathing sound due to obstruction of the larynx}}
{{Refimprove|date=June 2008}}
{{More citations needed|date=June 2008}}
{{Infobox medical condition (new)
{{Infobox medical condition (new)
| name = Stridor
| name = Stridor
| image = Stridor NP OGG 2.ogg
| image = Stridor NP OGG 2.ogg
| caption = Inspiratory and expiratory stridor in a 13-month child with [[croup]].
| caption = Inspiratory and expiratory stridor in a 13-month child with [[croup]]
| field = [[Otorhinolaryngology]], [[pediatrics]]
| field = [[Otorhinolaryngology]], [[pediatrics]]
| synonyms =
| synonyms =
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}}
}}


'''Stridor''' ([[Latin]] for "creaking or grating noise") is a high-pitched extra-thoracic [[respiratory sounds| breath sound]] resulting from [[turbulent]] air flow in the larynx or lower in the bronchial tree. It is different from a [[stertor]] which is a noise originating in the [[pharynx]]. Stridor is a physical sign which is caused by a narrowed or obstructed airway. It can be inspiratory, expiratory or biphasic, although it is usually heard during inspiration. Inspiratory stridor often occurs in children with [[croup]]. It may be indicative of serious [[airway]] obstruction from severe conditions such as [[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.
'''Stridor''' ({{ety|la||creaking/grating noise}}) is an extra-[[Thoracic cavity|thoracic]] high-pitched [[respiratory sounds|breath sound]] resulting from [[turbulent]] air flow in the [[larynx]] or lower in the [[bronchial tree]]. It is different from a [[stertor]], which is a noise originating in the [[pharynx]].
Stridor is a physical sign which is caused by a narrowed or [[Airway obstruction|obstructed airway]]. It can be [[Inhalation|inspiratory]], [[Exhalation|expiratory]] or [[Biphasic disease|biphasic]], although it is usually heard during inspiration. Inspiratory stridor often occurs in children with [[croup]]. It may be indicative of serious airway obstruction from severe conditions such as [[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==
==Causes==
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* [[vascular rings]] compressing the trachea;
* [[vascular rings]] compressing the trachea;
* thyroiditis such as [[Riedel's thyroiditis]];
* thyroiditis such as [[Riedel's thyroiditis]];
* vocal cord palsy;
* [[vocal cord]] palsy;
* [[tracheomalacia]] or tracheobronchomalacia (e.g., collapsed trachea).
* [[tracheomalacia]] or tracheobronchomalacia (e.g., collapsed trachea).
* [[congenital]] anomalies of the airway are present in 87% of all cases of stridor in infants and children.<ref name="pmid7436240">{{cite journal |author=Holinger LD |title=Etiology of stridor in the neonate, infant and child |journal=Ann. Otol. Rhinol. Laryngol. |volume=89 |issue=5 Pt 1 |pages=397–400 |year=1980 |pmid=7436240 |doi=}}</ref>
* [[congenital]] anomalies of the airway are present in 87% of all cases of stridor in infants and children.<ref name="pmid7436240">{{cite journal |author=Holinger LD |title=Etiology of stridor in the neonate, infant and child |journal=Ann. Otol. Rhinol. Laryngol. |volume=89 |issue=5 Pt 1 |pages=397–400 |year=1980 |doi=10.1177/000348948008900502 |pmid=7436240 |s2cid=20514618 }}</ref>
* [[vasculitis]].
* [[vasculitis]].
*infectious mononucleosis
*infectious mononucleosis
*peritonsillar abscess
*peritonsillar abscess
*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.)<ref>Wittekamp, Bastiaan HJ. Clinical review: Post-extubation laryngeal edema and extubation failure in critically ill adult patients. Crit Care. 2009; 13(6): 233.</ref>;
*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.);<ref>Wittekamp, Bastiaan HJ. Clinical review: Post-extubation laryngeal edema and extubation failure in critically ill adult patients. Crit Care. 2009; 13(6): 233.</ref>
* tumor (e.g., laryngeal papillomatosis, [[squamous cell carcinoma]] of larynx, trachea or esophagus);
* tumor (e.g., laryngeal papillomatosis, [[squamous cell carcinoma]] of larynx, trachea or esophagus);
* [[Acute lymphoblastic leukemia|ALL]] (T-cell ALL can present with mediastinal mass that compresses the trachea and causes inspiratory stridor)
* [[Acute lymphoblastic leukemia|ALL]] (T-cell ALL can present with mediastinal mass that compresses the trachea and causes inspiratory stridor)
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== External links ==
== External links ==
{{Wiktionary}}
{{Wiktionary}}
* [http://respwiki.com/Breath_sounds Audio Breath Sounds]—Multiple case studies with audio files of lung sounds.
* [http://respwiki.com/Breath_sounds Audio Breath Sounds] {{Webarchive|url=https://web.archive.org/web/20201215121532/http://respwiki.com/Breath_sounds |date=2020-12-15 }}—Multiple case studies with audio files of lung sounds.
* {{eMedicine|ped|2159|Stridor}}
* {{eMedicine|ped|2159|Stridor}}
* {{eMedicine|ped|2624|Congenital stridor}}
* {{eMedicine|ped|2624|Congenital stridor}}

Latest revision as of 04:23, 18 July 2024

Stridor
Inspiratory and expiratory stridor in a 13-month child with croup
SpecialtyOtorhinolaryngology, pediatrics

Stridor (from Latin 'creaking/grating noise') is an extra-thoracic high-pitched breath sound resulting from turbulent air flow in the larynx or lower in the bronchial tree. It is different from a stertor, which is a noise originating in the pharynx.

Stridor is a physical sign which is caused by a narrowed or obstructed airway. It can be inspiratory, expiratory or biphasic, although it is usually heard during inspiration. Inspiratory stridor often occurs in children with croup. It may be indicative of serious airway obstruction from severe conditions such as 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

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Stridor may occur as a result of:

Diagnosis

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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, bronchoscopy, CT-scans, and/or MRIs may reveal structural pathology.

Flexible fiberoptic bronchoscopy can also be very helpful, especially in assessing vocal cord function or in looking for signs of compression or infection.

Treatments

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The first issue of clinical concern in the setting of stridor is whether or not tracheal intubation or 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 racemic adrenaline epinephrine (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 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 (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 (70% helium, 30% 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 has shown to relieve symptoms by 80%.

References

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  1. ^ Holinger LD (1980). "Etiology of stridor in the neonate, infant and child". Ann. Otol. Rhinol. Laryngol. 89 (5 Pt 1): 397–400. doi:10.1177/000348948008900502. PMID 7436240. S2CID 20514618.
  2. ^ Wittekamp, Bastiaan HJ. Clinical review: Post-extubation laryngeal edema and extubation failure in critically ill adult patients. Crit Care. 2009; 13(6): 233.
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