Stridor

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Stridor
ICD-10 R06.1
ICD-9 786.1

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Luke Rusowicz-Orazem, B.S.

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
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 
Dental No underlying causes
Dermatologic Lepidopterism
Drug Side Effect 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
Endocrine Carcinoma of the thryoid, Estrogen dependent hereditary angioedema, Goiter, Hashimoto's disease, Intrathoracic goitre, Nodular goiter , Retrosternal thyroid, Riedel's thyroiditis, Thyroglossic cyst, Thyroidectomy
Environmental Foreign body aspiration, Inhaled foreign body
Gastroenterologic Caustic ingestion, Diffuse leiomyomatosis with alport syndrome , Gastroesophageal reflux disease, Pulmonary cystic lymphangiectasis , Pulmonary lymphangiectasia
Genetic C1 esterase inhibitor (c1-inh) deficiency, Choanal atresia, Compression of bronchii, Gay-feinmesser-cohen syndrome , Macroglossia
Hematologic 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
Iatrogenic Local anaesthetic allergy , Post-radiation, Prolonged intubation, Tracheal intubation, Tracheostomy, Transfusion reaction
Infectious Disease 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
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 
Nutritional/Metabolic Metabolic disorders, Potassium permanganate 
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 No underlying causes
Overdose/Toxicity Inhalant abuse , Morphine allergy 
Psychiatric Psychogenic
Pulmonary 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
Renal/Electrolyte Diffuse leiomyomatosis with alport syndrome , Wegener's granulomatosis
Rheumatology/Immunology/Allergy 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
Sexual Syphilis
Trauma 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
Urologic No underlying causes
Miscellaneous Angioedema, Angioneurotic edema, Linguinal angioedema

Causes in Alphabetical Order

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

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