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What is stridor?
Stridor is the noisy respiration due to obstruction of the air in and out of the lower respiratory tract. It is usually a symptom suggestive of a disease not a disease by itself.
What are the different types of Stridor?
- Inspiratory stridor: Seen in obstruction of the upper airway up to the larynx.
- Expiratory stridor: Seen in obstructive lesions at the bronchial level.
- Mixed: Both inspiratory and expiratory components are seen in the stridor
What are the causes of stridor?
Congenital:
- Laryngeal web
- Laryngomalacia
- Laryngeal stenosis
- Cysts of vocal cords
Inflammatory
- Acute epiglottitis
- Laryngitis
- Laryngeal edema
- Laryngotracheal bronchitis
- Tetanus
- Ludwig’s angina
Neoplastic
- Juvenile laryngeal papillomas
- Carcinoma larynx
Neurological
- Vocal cord palsy
- Tetany (laryngismus stridulus)
Trauma
- Burns
- Birth injury
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Intubation trauma
How is stridor diagnosed?
Detailed history:
- The onset of stridor
- Infective or congenital etiology
- History of foreign body aspiration
- Hoarseness of voice in the past
Clinical examination:
- Upper airway examination for any visible obstructive lesion
- Examination of the cardiovascular system
- To note signs of respiratory distress and cyanosis
- Examination of the neck for local trauma and injury
- Suprasternal inspiratory in-drawing
Investigation:
- X-ray neck lateral view to see the airway
- CT Scan neck and chest to know the exact cause and site of lesion
- Direct laryngoscopy and fiber optic bronchoscopy to confirm the diagnosis
- X-ray chest
How is stridor managed?
Management of stridor:
- Admission
- Oxygen
- Steroids, antibiotics
Treatment of cause
If severe respiratory distress or fatigue is present, Tracheostomy may be required. It should be noted that all cases of stridor must be treated as an emergency