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| ==Causes== | | ==Causes== |
| ===Common causes===
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| Stridor has many different potential causes. It may occur as a result of:
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| * foreign bodies (e.g., [[Pulmonary aspiration|aspirated]] [[peanut]], aspirated wire),
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| * tumor formation (e.g., laryngeal papillomatosis, [[squamous cell carcinoma]]),
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| * infections (e.g., [[epiglottitis]], retropharyngeal abscess, [[croup]]),
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| * subglottic [[stenosis]] (e.g., following prolonged intubation or congenital),
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| * airway edema (e.g., following instrumentation of the airway [[intubation]], drug side effect, [[allergic reaction]]),
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| * as well as a result of [[laryngomalacia]] (the most common congenital cause of stridor),
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| * subglottic [[hemangioma]] (rare),
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| * and [[vascular rings]] compressing the trachea.
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| * Abnormalities of vocal cord function can also be responsible.
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| * [[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>
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| * Drug side effects: [[tuberculin]]
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| ===Complete differential diagnosis of causes of stridor===
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| ===Common Causes=== | | ===Common Causes=== |
| ====Inspiratory stridor==== | | ====Inspiratory stridor==== |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
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.
Causes
Common Causes
Inspiratory stridor
Expiratory stridor
Causes by Organ System
| Cardiovascular
|
Aberrant subclavian artery abnormality , Aortic aneurysm, Cardiac failure, Double aortic arch, Ludwig's angina, Partial atrioventricular canal , Thoracic aortic aneurysm, Vascular rings, Vasculitis
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| Chemical/Poisoning
|
Acetic acid , Acrylic acid , Ammonia , Arizona bark scorpion poisoning , Aromatic amino acid decarboxylase deficiency , Athyl-gusathion , Browntail moth caterpillar poisoning , Cadusafos , Calcium hypochlorite , Chlorfenvinphos , Chlorine dioxide , Chlorine , Chloropyrifos , Empc , Ethoate-methyl , Ethylenediamine , Ethyl-guthion , Formaldehyde , Fresh mangrove caterpillar poisoning , Glutaraldehyde , Grapeleaf skeletonizer caterpillar poisoning , Guthion (ethyl) , Methomyl , Nickel , Oxamyl , Palladium , Paragonimiases , Parathion methyl , Platinum , Primiphos methyl , Profenofos , Promacyl , Pyrimitate , Quinalphos , Quintiofos , Satin moth caterpillar poisoning , Silver , Sophamide , Spice allergy , Stinging bark caterpillar poisoning , Stinging nettle caterpillar poisoning , Stinging rose caterpillar poisoning , Tacrine toxicity , Tolclofos methyl , Uranium , Vanadium toxicity , Vanadium , Weeping fig poisoning
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| Dental
|
No underlying causes
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| Dermatologic
|
Lepidopterism
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| Drug Side Effect
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Acenaphthene , Alanycarb , Aldicarb , Aldoxycarb , Allyxycarb , Amidithion , Aminocarb , Amiton , Azinfosethyl , Azinphos , Azinphosmetile , Azothoate , Barium , Bendiocarb , Benfuracarb , Benoxafos , Bromophos , Bufencarb , Butacarb , Butocarboxim , Captafol , Carbanolate , Carbaryl , Carbofuran , Carbophenothion , Carbosulfan , Cloethocarb , Cyanthoate , Decarbofuran , Demeton , Dialifos , Diazinon , Dichlorvos , Dicresyl , Dicrotophos , Dimetan , Dimethoate , Dimetilan , Dioxacarb , Dioxathion , Disulfoton , Drug allergies , Endothion , Ethiofencarb , Ethion , Ethoprophos , Etrimfos , Fenchlorphos , Fenethacarb , Fenitrothion , Fenobucarb , Fensulfothion , Fenthion , Fonophos , Formothion , Furathiocarb , Heptenophos , Hexamethylene diisocyanate , Hyquincarb , Iodofenphos , Isoprocarb , Malathion , Mecarbam , Methacrifos , Methamidophos , Methidathion , Methiocarb , Metiltriazotion , Metolcarb , Mevinphos , Mexacarbate , Monocrotophos , Nitrilacarb , Novacaine drug allergy , Omethoate , Osmium , Oxydeprofos , Oxydisulfoton , Phenkapton , Phorate , Phosalone , Phosdrin , Phosgene oxime , Phosmet , Phosphamidon , Phoxim , Pirimicarb , Pirimiphos-methyl , Promecarb , Propoxur , Prothidathion , Prothoate , Sulfotep , Sulfur trioxide , Tazimcarb , Terbufos , Tetraethyl pyrophosphate , Thiocarboxime , Thiodicarb , Thiofanox , Thiometon , Triazophos , Triazotion , Trifenfos , Trimellitic anhydride , Trimethacarb , Tuberculin, Vamidothion , Vanadium toxicity , Vanadium , Xmc , Xylylcarb
|
| Ear Nose Throat
|
Acute epiglottitis, Acute laryngitis, Acute laryngotracheobronchitis, Acute pseudo-membranous croup, Adenoid cystic carcinoma , Airway edema, Airway obstruction, Airway trauma, Carcinoma of larynx, Carcinoma of the esophagus, Carcinoma of trachea, Cellulitis of neck, Chronic tuberculous laryngitis, Congenital laryngeal anomalies, Congenital laryngeal paralysis in newborns, Congenital laryngeal stridor, Congenital subglottic narrowing, Congenital tracheal anomalies, Cricoarytenoid ankylosis, Croup , Deviated septum, Dislocated cricothyroid or cricoarytenoid articulation, Edema of the glottis, Enlarged adenoids, Enlarged tonsils, Epiglottitis, Gerhardt syndrome, Idiopathic subglottic tracheal stenosis , Injury to larynx, Injury to trachea, Internal laryngeal trauma, Laryngeal cleft, Laryngeal cyst, Laryngeal fracture, Laryngeal inflammation, Laryngeal nerve palsy, Laryngeal or tracheal abnormalities, Laryngeal papilloma, Laryngeal papillomatosis, Laryngeal stenosis, Laryngeal web, Laryngitis, Laryngocele , Laryngomalacia , Laryngoscopy, Laryngospasm, Laryngotracheitis, Laryngotracheobronchitis, Larynx atresia , Larynx carcinoma, Larynx condition, Macroglossia, Malignant disease of lower cervical lymph nodes, Nasal polyp, Nasal septum deviation, Nasopharyngeal mass, Neck or facial swelling, Piriform aperture stenosis, Polychondritis, Post-traumatic stenosis of larynx, Post-traumatic stenosis of the trachea, Retropharyngeal abscess, Rhinosinusitis, Small jaw, Smokers throat , Smoking cessation , Subglottic stenosis, Supraglottic webs, Syphilitic laryngitis with stenosis, Tonsillitis, Tracheal cancer , Tracheal intubation, Tracheal stenosis, Tracheobronchomalacia, Tracheobronchopathia osteoplastica , Tracheolaryngobronchitis, Tracheomalacia, Tracheopathia osteoplastica, Tracheostomy, Trachiobronchitis, Tumor infiltration, Upper airway burns, Vocal cord cancer, Vocal cord paralysis
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| Endocrine
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Carcinoma of the thryoid, Estrogen dependent hereditary angioedema, Goiter, Hashimoto's disease, Intrathoracic goitre, Nodular goiter , Retrosternal thyroid, Riedel's thyroiditis, Thyroglossic cyst, Thyroidectomy
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| Environmental
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Foreign body aspiration, Inhaled foreign body
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| Gastroenterologic
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Caustic ingestion, Diffuse leiomyomatosis with alport syndrome , Gastroesophageal reflux disease, Pulmonary cystic lymphangiectasis , Pulmonary lymphangiectasia
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| Genetic
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C1 esterase inhibitor (c1-inh) deficiency, Choanal atresia, Compression of bronchii, Gay-feinmesser-cohen syndrome , Macroglossia
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| Hematologic
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Acute lymphoblastic leukemia, Anaphylaxis , Aortic aneurysm, C1 esterase inhibitor (c1-inh) deficiency, Classical hodgkin disease , Granulomatosis with polyangiitis, Hodgkin's disease , Lymphocyte depletion hodgkin's disease , Mastocytosis , Mediastinal hodgkin's disease, Mixed cellularity hodgkin's disease , Nodular sclerosing hodgkin's lymphoma , Subglottic hemangioma, Transfusion reaction
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| Iatrogenic
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Local anaesthetic allergy , Post-radiation, Prolonged intubation, Tracheal intubation, Tracheostomy, Transfusion reaction
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| Infectious Disease
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Acute diphtheria, Acute epiglottitis, Acute laryngitis, Acute laryngotracheobronchitis, Acute pseudo-membranous croup, Adenovirus, Bronchial asthma, Bronchiolitis obliterans , Bronchitis, Bronchogenic cyst, Cellulitis of neck, Common cold, Croup , Diptheria, Epiglottitis, Infectious conditions, Infectious mononucleosis, Laryngeal cyst, Laryngeal inflammation, Laryngitis, Lingual cyst, Metapneumovirus , Peritonsillar abscess, Pneumonia, Retropharyngeal abscess, Rhinosinusitis, Spasmodic croup, Sputum, Syphilis, Tonsillitis, Tracheobronchomalacia, Tracheolaryngobronchitis, Trachiobronchitis, Tuberculosis, Tuberculous nodes in mediastinum, Tuberculous strictures of main bronchi
|
| Musculoskeletal/Orthopedic
|
Bronchopathia osteoplastica, Bronchopulmonary dysplasia, Mandibular fracture, Maxillo-facial dysplasis, Polychondritis, Tracheobronchopathia osteoplastica , Tracheopathia osteoplastica
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| Neurologic
|
Arnold-chiari malformation type 2 , Bulbar palsy, Craniofacial anomaly, Down's syndrome, Hydrocephalus, Laryngeal nerve palsy, Nerve paresis, Neural tube defect , Primary ciliary dyskinesia, Pseudobulbar palsy, Shy-drager syndrome
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| Nutritional/Metabolic
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Metabolic disorders, Potassium permanganate
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| Obstetric/Gynecologic
|
Acute lymphoblastic leukemia, Adenoid cystic carcinoma , Benign tumor of larynx, Benign tumor of trachea, Bronchial carcinoma, Bronchogenic carcinoma , Carcinoid , Carcinoma of larynx, Carcinoma of the esophagus, Carcinoma of the thryoid, Carcinoma of trachea, Epidermoid carcinoma , Hemangioma, Hodgkin's lymphoma , Laryngeal carcinoma , Laryngeal papilloma, Laryngeal papillomatosis, Lung cancer , Malignant disease of lower cervical lymph nodes, Malignant germ cell tumor , Mastocytosis , Mediastinal tumors, Mesothelioma , Mixed type non small cell carcinoma , Nodular sclerosing hodgkin's lymphoma , Pulmonary pseudolymphoma , Respiratory tract cancer , Small cell lung cancer , Squamous cell carcinoma, Subglottic hemangioma, Thymic epithelial tumor , Thyroidectomy, Tracheal cancer , Tumor infiltration, Vocal cord cancer
|
| Oncologic
|
Acute lymphoblastic leukemia, Adenoid cystic carcinoma , Benign tumor of larynx, Benign tumor of trachea, Bronchial carcinoma, Bronchogenic carcinoma , Carcinoid , Carcinoma of larynx, Carcinoma of the esophagus, Carcinoma of the thryoid, Carcinoma of trachea, Epidermoid carcinoma , Hemangioma, Hodgkin's lymphoma , Laryngeal carcinoma , Laryngeal papilloma, Laryngeal papillomatosis, Lung cancer , Malignant disease of lower cervical lymph nodes, Malignant germ cell tumor , Mastocytosis , Mediastinal tumors, Mesothelioma , Mixed type non small cell carcinoma , Nodular sclerosing hodgkin's lymphoma , Pulmonary pseudolymphoma , Respiratory tract cancer , Small cell lung cancer , Squamous cell carcinoma, Subglottic hemangioma, Thymic epithelial tumor , Thyroidectomy, Tracheal cancer , Tumor infiltration, Vocal cord cancer
|
| Ophthalmologic
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No underlying causes
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| Overdose/Toxicity
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Inhalant abuse , Morphine allergy
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| Psychiatric
|
Psychogenic
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| Pulmonary
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Aspiration, Asthma-like conditions , Bronchial carcinoma, Bronchial asthma, Bronchiolitis obliterans , Bronchitis, Bronchogenic carcinoma , Bronchogenic cyst, Bronchomalacia, Bronchopathia osteoplastica, Bronchopulmonary dysplasia, Bronchoscopy , Byssinosis , Chronic lower respiratory diseases , Chronic obstructive pulmonary disease, Chronic tuberculous laryngitis, Compression of bronchii, Congenital bronchial anomalies, Congenital laryngeal anomalies, Diptheria, Food allergy related asthma , Foreign body aspiration, Inhalation injury, Inhaled foreign body, Lung cancer , Mesothelioma , Non-small cell lung cancer , Occupational asthma, Pleura process, Pneumonia, Pneumothorax, Pulmonary cystic lymphangiectasis , Pulmonary lymphangiectasia, Recurrent respiratory papillomatosis , Respiratory tract cancer , Sarcoidosis, Small cell lung cancer , Sputum, Strictures of main bronchi in sarcoidosis, Tuberculosis, Tuberculous nodes in mediastinum, Tuberculous strictures of main bronchi
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| Renal/Electrolyte
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Diffuse leiomyomatosis with alport syndrome , Wegener's granulomatosis
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| Rheumatology/Immunology/Allergy
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Allergic reaction, Ankylosis of crico-arytenoid joint in rheumatoid arthritis, Food additive allergy , Food allergies , Insect allergy , Latex catheters induced allergies , Local anaesthetic allergy , Peanut allergy , Penicillin allergy , Rheumatoid disease, Scar stenosis, Seafood allergy , Spice allergy , Sulfa antibiotics allergy , Wegener's granulomatosis
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| Sexual
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Syphilis
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| Trauma
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Burn injuries, Facial fracture, Inhalation injury, Injury to larynx, Injury to trachea, Internal laryngeal trauma, Laryngeal fracture, Mandibular fracture, Pepper spray , Post-traumatic stenosis of larynx, Post-traumatic stenosis of the trachea, Smokers throat , Trauma, Upper airway burns
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| Urologic
|
No underlying causes
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| Miscellaneous
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Angioedema, Angioneurotic edema, Linguinal angioedema
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Causes in Alphabetical Order
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3
Treatments
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.
Diagnosis
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.
References
External links
de:Stridor
nl:Stridor
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