Table 1

Causes of stridor with their main diagnosis and therapeutic specificities

Causes of stridorEpidemiological factorsUnusual clinical presentationImmediate managementOther useful tests and treatments
Foreign body inhalationChildren <3 year-old
Swallowing disorders
Loss of consciousness
Sudden non-febrile stridor
Witnessed episode of choke
Heimlich manoeuvre
Direct laryngoscopy
or tracheotomy/cricothyrotomy
Chest radiograph, CT scan of thorax
AnaphylaxisAllergiesSudden non-febrile stridor
Swollen face and urticaria
Parenteral adrenaline injection±Intubation
or tracheotomy/cricothyrotomy
Post extubation
 Vocal cords oedemaStridor immediately after extubation
Sore throat, dysphonia, dysphagia
Improves in 24–48 h
Nebulisation of adrenaline and steroids
 Laryngeal injuryProlonged intubation
Traumatic intubation
Large endotracheal tube
Stridor immediately after extubation
Hoarse voice or dysphonia
Direct laryngoscopy
Various therapeutic options
 Tracheal stenosisHigh endotracheal tube balloon pressureProgressive stridor and dyspnoea after extubation
May remain silent for years
BronchoscopyCT scan of thorax
Various therapeutic options
Trauma/fireThink particularly to life-threatening injury in case of stridor after direct impact on the glottis or tracheaIntubation
or tracheotomy/cricothyrotomy are often needed
Most often surgical treatment
 EpiglottisChildren with immune deficiency
Lack of Haemophilus influenzae B vaccination
Rapid respiratory febrile stridor and respiratory distress
Upright posture – sniffing position
Dysphagia, muffled voice
Do not lie down
No tongue-blade examination
or tracheotomy/cricothyrotomy
Empiric antibiotics
Neck soft tissue x-ray: thumb sign
Epiglottis sample culture
Blood cultures
 CroupChildren 6 months to 3 year old
community epidemic
Progressive febrile stridor
upright position
barking cough
Oral or parental dexamethasone
Nebulisation of adrenaline
 DiphtheriaLack of vaccination for Corynebacterium diphtheriaeProgressive stridor
low grade fever
Preceded by rhinorrhoea, sore throat, cervical lymph nodes
Grey pseudomembranes in the airways
Empiric antibioticsCulture of pseudomembranes
Droplet's isolation for patient contacts’ investigation
 TracheitisSeasonal epidemic of parainfluenza, influenza and RSVAcute stridor with high fever and respiratory distress
Prefers to lie down
Toxic appearance
Empiric antibiotics
Culture of bronchial aspiration
Expansive process
Endoluminal obstructionAirways compressionOthers
Primary laryngeal or lung cancerSecondary metastasis: lung, renal, breast, thyroid, colon, sarcoma, melanomaBenign tumours: papillomatosis, sarcoidosis, amyloidosis, hamartomasGranulation tissue: post intubation/tracheostomy/stenting, foreign bodies, surgical anastomosis, granulomatosis with polyangiitisMucus plus blood clotsMediastinal mass:
Malignant: thymus, thyroid, germ cell
Benign: goitreLymph nodes:
Malignant: metastasis, lymphoma
Benign: tuberculosis
Glottic or tracheal stenosis (prolonged intubation, irradiation, congenital, idiopathic…)Tracheomalacia, relapsing polychondritisLaryngomalaciaLaryngospasmBilateral vocal cord palsyVocal cord dysfunctionWebs