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Stridor
From WikEM
Contents
- 1 Background
- 2 Clinical Features
- 3 Differential Diagnosis
- 3.1 Stridor
- 3.1.1 Trauma
- 3.1.2 Infectious Disorders
- 3.1.3 Abscesses
- 3.1.4 Neoplastic Disorders
- 3.1.5 Allergic and Auto-Immune Disorders
- 3.1.6 Metabolic, Storage Disorders
- 3.1.7 Biochemical Disorders
- 3.1.8 Congenital, Developmental Disorders
- 3.1.9 Psychiatric Disorders
- 3.1.10 Anatomical or Mecanical
- 3.1.11 Vegetative, Autonomic, Endocrine Disorders
- 3.1.12 Poisoning
- 3.1.13 Chronic Pediatric Conditions
- 3.1 Stridor
- 4 Evaluation
- 5 Management
- 6 Disposition
- 7 See Also
- 8 External Links
- 9 References
Background
- Stridor refers to harsh upper airway sounds, classically inspiratory
Clinical Features
- Inspiratory stridor
- Suggestive of extrathoracic obstruction (Pressuretrach < Pressureatm)
- Croup, metapneumovirus, FB, epiglottitis
- Expiratory stridor vs. wheezing
- Suggestive of intrathoracic obstruction (Pressuretrach < Pressurepleura)
- Asthma, bronchiolitis
Differential Diagnosis
Stridor
Trauma
- Larynx fracture
- Tracheobronchial tear/injury
- Thyroid gland injury/trauma
- Trachea injury
- Electromagnetic or radiation exposure
- Burns, inhalation
Infectious Disorders
- Bacterial tracheitis
- Diphtheria
- Tetanus
- Tracheobronchial tuberculosis
- Poliomyelitis, paralytic, bulbar
- Poliomyelitis, acute
- Fungal laryngitis
Abscesses
- Retropharyngeal abscess
- Epiglottitis, acute
- Peritonsillar abscess
- Laryngotracheobronchitis, acute
- Retropharyngeal abscess
Neoplastic Disorders
- Neoplasms/tumors
Allergic and Auto-Immune Disorders
- Croup, spasmodic/tracheobronchitis
- Angioedema/Angioneurotic edema
Metabolic, Storage Disorders
- Cerebral Gaucher's of infants (acute)
- Tracheobronchial amyloidosis
Biochemical Disorders
- Tetany
Congenital, Developmental Disorders
- Angioedema/Angioneurotic edema, hereditary
Psychiatric Disorders
- Somatization disorder
Anatomical or Mecanical
- Foreign Body Aspiration
- Acute gastric acid/aspiration syndrome
- Airway obstruction
- Neck compartment hemorrhage/hematoma
Vegetative, Autonomic, Endocrine Disorders
- Esophageal free reflux/GERD syndrome
- Laryngospasm, acute
- Bilateral vocal cord paralysis
- Hypoparathyroidism
Poisoning
- Smoke inhalation
- Chemical burn/esophagus
Chronic Pediatric Conditions
- Laryngomalacia
- Tracheomalacia
- Subglottic stenosis or prior intubation
- Vascular ring (double aortic arch)
- Vocal cord dysfunction/paroxysmal vocal fold movement
Evaluation
- Assess airway
- If unstable, see Difficult Airway Algorithm, Intubation and consider surgical intervention/consultation
- If stable, consider imaging or direct visualization of larynx with fiberoptic scope or video laryngoscope GEMC:Airway Procedures
- CT of neck if mass/infection suspected
Management
- Treat underlying cause
Disposition
- Based on underlying cause
