Name of Symptom/Sign:
Classifications and external resources
Stridor is a high pitched sound resulting from turbulent gas flow in the upper airway. It may be inspiratory, expiratory or present on both inspiration and expiration. It can be indicative of serious airway obstruction from severe conditions such as epiglottitis, a foreign body lodged in the airway, or a laryngeal tumor. 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.) That examination requires visualization of the airway by a team of medical experts equipped to control the airway.
The first issue of clinical concern in the setting of stridor is whether or not tracheal intubation or tracheostomy 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 nebulized racemic 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 Cocaine in a dose not exceeding 3 mg/kg may also be used, but not together with racemic epinephrine [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 need for dexamethasone to work fully.
- Use of inhaled Heliox (70% helium, 30% oxygen); the effect is almost instantaneous
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 or congenital),
- airway edema (e.g., following instrumentation of the airway intubation, drug side effect, allergic reaction),
- 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.
Stridor is usually diagnosed 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.
- ^ Holinger LD (1980). "Etiology of stridor in the neonate, infant and child". Ann. Otol. Rhinol. Laryngol. 89 (5 Pt 1): 397–400. PMID 7436240.
|Symptoms and signs (R00-R69, 780-789)|
|Tachycardia - Bradycardia - Palpitation - Heart murmur - Epistaxis - Hemoptysis - Cough - abnormalities of breathing (Dyspnea, Orthopnoea, Stridor, Wheeze, Cheyne-Stokes respiration, Hyperventilation, Mouth breathing, Hiccup, Bradypnea, Hypoventilation) - Chest pain - Asphyxia - Pleurisy - Respiratory arrest - Sputum - Bruit/Carotid bruit - Rales|
|Digestive system and abdomen||Abdominal pain (Acute abdomen) - Nausea/Vomiting - Heartburn - Dysphagia - flatulence and related (Abdominal distension, Bloating, Burping, Tympanites) - Fecal incontinence (Encopresis) - hepatosplenomegaly (Hepatomegaly, Splenomegaly) - Jaundice - Ascites - Fecal occult blood - Halitosis|
|Skin and subcutaneous tissue||disturbances of skin sensation (Hypoesthesia, Paresthesia, Hyperesthesia) - Rash - Cyanosis - Pallor - Flushing - Petechia - Desquamation - Induration - Diaphoresis|
|abnormal involuntary movements (Tremor, Spasm, Fasciculation, Athetosis) - Gait abnormality - lack of coordination (Ataxia, Dysmetria, Dysdiadochokinesia, Hypotonia) - Tetany - Meningism - Hyperreflexia|
|Urinary system||Renal colic - Dysuria - Vesical tenesmus - Urinary incontinence - Urinary retention - Oliguria - Polyuria - Nocturia - Extravasation of urine - Extrarenal uremia|
emotional state and behaviour
|Anxiety - Somnolence - Coma - Amnesia (Anterograde amnesia, Retrograde amnesia) - Dizziness/Vertigo - smell and taste (Anosmia, Ageusia, Parosmia, Parageusia)|
|Speech and voice||speech disturbances (Dysphasia, Aphasia, Dysarthria) - symbolic dysfunctions (Dyslexia, Alexia, Agnosia, Apraxia, Acalculia, Agraphia) - voice disturbances (Dysphonia, Aphonia)|
|General symptoms and signs||Fever (Hyperpyrexia) - Headache - Chronic pain - Malaise/Fatigue (Asthenia, Debility) - Fainting (Vasovagal syncope) - Febrile seizure - Shock (Cardiogenic shock) - Lymphadenopathy - Edema (Peripheral edema, Anasarca) - Hyperhidrosis (Sleep hyperhidrosis) - Delayed milestone - Failure to thrive - Short stature (Idiopathic) - food and fluid intake (Anorexia, Polydipsia, Polyphagia) - Cachexia - Xerostomia - Clubbing|