Stridor

Definition

Stridor is an abnormal, high-pitched, musical breathing sound. It is caused by a blockage in the throat or voice box (larynx). It is most often heard when taking in a breath.

Alternative Names

Breathing sounds - abnormal; Extrathoracic airway obstruction; Wheezing - stridor

Considerations

Children are at higher risk of airway blockage because they have narrower airways than adults. In young children, stridor is a sign of airway blockage. It must be treated right away to prevent the airway from becoming completely closed.

The airway can be blocked by an object, swollen tissues of the throat or upper airway, or a spasm of the airway muscles or the vocal cords.

Causes

Common causes of stridor include:

• Airway injury
• Allergic reaction
• Problem breathing and a barking cough (croup)
• Diagnostic tests such as bronchoscopy or laryngoscopy
• Epiglottitis, inflammation of the cartilage that covers the windpipe
• Inhaling an object such as a peanut or marble (foreign body aspiration)
• Swelling and irritation of the voice box (laryngitis)
• Neck surgery
• Use of a breathing tube for a long time
• Secretions such as phlegm (sputum)
• Smoke inhalation or other inhalation injury
• Swelling of the neck or face
• Swollen tonsils or adenoids (such as with tonsillitis)
• Vocal cord cancer

Home Care

Follow your health care provider's advice to treat the cause of the problem.

When to Contact a Medical Professional

Stridor may be a sign of an emergency. Call your provider right away if there is unexplained stridor, especially in a child.

What to Expect at Your Office Visit

In an emergency, the provider will check the person's temperature, pulse, breathing rate, and blood pressure, and may need to do abdominal thrusts.

A breathing tube may be needed if the person can't breathe properly.

After the person is stable, the provider may ask about the person's medical history, and perform a physical exam. This includes listening to the lungs.

Parents or caregivers may be asked the following medical history questions:

• Is the abnormal breathing a high-pitched sound?
• Did the breathing problem start suddenly?
• Could the child have put something in their mouth?
• Has the child been ill recently?
• Is the child's neck or face swollen?
• Has the child been coughing or complaining of a sore throat?
• What other symptoms does the child have? (For example, nasal flaring or a bluish color to the skin, lips, or nails)
• Is the child using chest muscles to breathe (intercostal retractions)?

Tests that may be done include:

• Arterial blood gas analysis
• Bronchoscopy
• Chest CT scan
• Laryngoscopy (examination of the voice box)
• Pulse oximetry to measure blood oxygen level
• X-ray of the chest or neck

References

Griffiths AG. Chronic or recurrent respiratory symptoms. In: Kliegman RM, St. Geme JW, Blum NJ, Shah SS, Tasker RC, Wilson KM, eds. Nelson Textbook of Pediatrics. 21st ed. Philadelphia, PA: Elsevier; 2020:chap 401.

Rose E. Pediatric respiratory emergencies: upper airway obstruction and infections. In: Walls RM, Hockberger RS, Gausche-Hill M, eds. Rosen's Emergency Medicine: Concepts and Clinical Practice. 9th ed. Philadelphia, PA: Elsevier; 2018:chap 167.