Stridor: Symptoms, Causes, Treatment

What are the symptoms of stridor?

Stridor is a high-pitched, wheezing or squeaking sound that occurs when there is a blockage or narrowing in the upper airway. It is often indicative of a respiratory condition affecting the larynx (voice box) or trachea (windpipe). The symptoms of stridor include:

1. High-Pitched Breathing Sounds

• Inhalation Stridor: A high-pitched sound heard primarily during inhalation. This is commonly due to obstruction in the upper airway.
• Exhalation Stridor: Less common but can occur if there is significant airway obstruction affecting both inhalation and exhalation.

2. Difficulty Breathing

• Breathing Difficulty: Stridor is often associated with labored or difficulty breathing, especially if the airway is significantly obstructed.

3. Coughing

• Persistent Cough: A cough may accompany stridor, particularly if there is an underlying condition causing irritation or inflammation in the airway.

4. Hoarseness or Voice Changes

• Voice Changes: Stridor may be associated with hoarseness or changes in the voice if the larynx is affected.

5. Respiratory Distress

• Signs of Distress: In severe cases, stridor can lead to respiratory distress, characterized by rapid breathing, use of accessory muscles for breathing, and cyanosis (bluish discoloration of the skin or lips).

6. Swelling or Irritation

• Swelling: Symptoms such as swelling of the throat or neck can occur if there is an underlying condition causing stridor, such as croup or an allergic reaction.

7. Fever

• Fever: In some cases, stridor may be associated with fever, particularly if an infection is causing inflammation in the airway.

Stridor can be a sign of a potentially serious condition, such as croup, epiglottitis, or an upper airway obstruction. If you or someone else is experiencing stridor, especially if it is accompanied by difficulty breathing, severe distress, or sudden onset, it is important to seek medical attention promptly. A healthcare provider will evaluate the underlying cause and determine the appropriate treatment to address the airway obstruction and manage symptoms.

What are the causes of stridor?

Stridor is caused by a narrowing or obstruction in the upper airway, which can be due to various conditions. Here are common causes of stridor:

1. Infections

• Croup: Often caused by a viral infection, croup leads to inflammation and swelling of the upper airway, resulting in a characteristic barking cough and stridor.
• Epiglottitis: A potentially life-threatening infection causing inflammation and swelling of the epiglottis (the flap at the base of the tongue), which can block the airway.

2. Allergic Reactions

• Anaphylaxis: Severe allergic reactions can cause swelling of the throat and upper airway, leading to stridor and difficulty breathing.

3. Foreign Body Obstruction

• Inhaled Objects: Objects inhaled into the airway can cause obstruction and stridor, especially in children.

4. Laryngeal and Tracheal Conditions

• Laryngomalacia: A congenital condition in infants where the soft, floppy tissue above the vocal cords collapses inward during inhalation.
• Tracheomalacia: A condition where the trachea (windpipe) is weak and collapses, leading to airway obstruction and stridor.
• Vocal Cord Paralysis: Paralysis of the vocal cords can cause stridor due to impaired airway function.

5. Tumors and Growths

• Laryngeal Tumors: Benign or malignant tumors in the larynx (voice box) can cause stridor by obstructing the airway.
• Subglottic Stenosis: Narrowing of the airway just below the vocal cords can cause stridor.

6. Trauma and Injury

• Injury: Trauma to the throat or neck can cause swelling or structural damage that leads to stridor.

7. Congenital Anomalies

• Congenital Stridor: Some infants are born with structural abnormalities of the airway that cause stridor.

8. Inflammatory Conditions

• Granulomatosis with Polyangiitis (Wegener’s Granulomatosis): An autoimmune condition that can cause inflammation and obstruction of the upper airway.

9. Post-Surgical Complications

• Intubation: Complications from intubation or tracheostomy, such as edema or scarring, can cause stridor.

10. Acid Reflux

• Laryngopharyngeal Reflux: Acid reflux that irritates the larynx can sometimes cause stridor.

11. Swelling

• Angioedema: Rapid swelling of the tissues in the throat, often related to allergic reactions or medication side effects, can cause stridor.

If stridor is present, especially if it occurs suddenly, is severe, or is accompanied by difficulty breathing or other concerning symptoms, seeking prompt medical evaluation is essential. The underlying cause of stridor must be identified and treated appropriately to ensure effective management and relief.

What is the treatment for stridor?

The treatment for stridor depends on its underlying cause and severity. Addressing the root cause of the airway obstruction or narrowing is crucial. Here’s an overview of common treatments for stridor based on its cause:

1. Infections

• Croup: Often treated with corticosteroids (such as dexamethasone) to reduce inflammation. In severe cases, nebulized epinephrine may be used to provide temporary relief.
• Epiglottitis: Requires immediate medical attention. Treatment typically includes intravenous antibiotics and sometimes airway management, such as intubation, to secure the airway.

2. Allergic Reactions

• Anaphylaxis: Immediate treatment with epinephrine is essential. Other treatments may include antihistamines and corticosteroids to reduce swelling and inflammation.

3. Foreign Body Obstruction

• Removal: The foreign object causing obstruction should be removed, often through procedures such as bronchoscopy or endoscopy, depending on its location.

4. Laryngeal and Tracheal Conditions

• Laryngomalacia: Often resolves on its own in infants, but severe cases might require surgical intervention if breathing difficulties persist.
• Tracheomalacia: Management might include supportive care, monitoring, and in severe cases, surgical interventions such as tracheal stenting.
• Vocal Cord Paralysis: Treatment depends on the underlying cause. Options might include voice therapy, surgery, or injection of substances to improve vocal cord function.

5. Tumors and Growths

• Surgical Removal: Tumors or growths causing obstruction may need to be surgically removed, followed by additional treatments such as radiation or chemotherapy if malignant.

6. Trauma and Injury

• Medical Management: Treatment involves addressing the injury, reducing swelling, and ensuring airway patency. In some cases, surgical intervention may be required.

7. Congenital Anomalies

• Surgical Correction: Congenital abnormalities may require surgical correction, often in a specialized medical center.

8. Inflammatory Conditions

• Medications: Treatment with corticosteroids or other anti-inflammatory medications may be used to reduce inflammation and manage symptoms.

9. Post-Surgical Complications

• Follow-up Care: Management includes monitoring and treating any complications from previous procedures, such as airway swelling or scarring.

10. Acid Reflux

• Medication: Treatment for acid reflux includes antacids, H2 blockers, or proton pump inhibitors to reduce stomach acid and prevent further irritation.

11. Swelling

• Medications: Treatment with antihistamines or corticosteroids to reduce swelling, depending on the cause.

General Measures

• Oxygen Therapy: If there is significant difficulty breathing, supplemental oxygen may be provided to improve oxygenation.
• Airway Management: In severe cases, interventions such as intubation or tracheostomy may be necessary to secure the airway.

Prompt evaluation by a healthcare provider is essential for determining the specific cause of stridor and implementing the appropriate treatment. In cases of acute stridor or significant respiratory distress, immediate medical attention is necessary to ensure proper management and care.