Causes of stridor with their main diagnosis and therapeutic specificities
| Causes of stridor | Epidemiological factors | Unusual clinical presentation | Immediate management | Other useful tests and treatments |
| Acute | ||||
| Foreign body inhalation | Children <3 year-old Swallowing disorders Loss of consciousness | Sudden non-febrile stridor Witnessed episode of choke | Heimlich manoeuvre Direct laryngoscopy ±Intubation or tracheotomy/cricothyrotomy | Chest radiograph, CT scan of thorax Bronchoscopy |
| Anaphylaxis | Allergies | Sudden non-febrile stridor Swollen face and urticaria | Parenteral adrenaline injection | ±Intubation or tracheotomy/cricothyrotomy |
| Post extubation | ||||
| Vocal cords oedema | Stridor immediately after extubation Sore throat, dysphonia, dysphagia Improves in 24–48 h | Nebulisation of adrenaline and steroids | ||
| Laryngeal injury | Prolonged intubation Traumatic intubation Large endotracheal tube | Stridor immediately after extubation Hoarse voice or dysphonia | Direct laryngoscopy ±Reintubation | Various therapeutic options |
| Tracheal stenosis | High endotracheal tube balloon pressure | Progressive stridor and dyspnoea after extubation May remain silent for years | Bronchoscopy | CT scan of thorax Various therapeutic options |
| Trauma/fire | Think particularly to life-threatening injury in case of stridor after direct impact on the glottis or trachea | Intubation or tracheotomy/cricothyrotomy are often needed | Most often surgical treatment | |
| Infections | ||||
| Epiglottis | Children 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 ±Intubation or tracheotomy/cricothyrotomy Empiric antibiotics | Neck soft tissue x-ray: thumb sign Epiglottis sample culture Blood cultures |
| Croup | Children 6 months to 3 year old community epidemic | Progressive febrile stridor upright position barking cough | Oral or parental dexamethasone Nebulisation of adrenaline ±Intubation | |
| Diphtheria | Lack of vaccination for Corynebacterium diphtheriae | Progressive stridor low grade fever Preceded by rhinorrhoea, sore throat, cervical lymph nodes Grey pseudomembranes in the airways | Empiric antibiotics | Culture of pseudomembranes Droplet's isolation for patient contacts’ investigation |
| Tracheitis | Seasonal epidemic of parainfluenza, influenza and RSV | Acute stridor with high fever and respiratory distress Prefers to lie down Toxic appearance | Bronchoscopy Empiric antibiotics | Culture of bronchial aspiration |
| Chronic/recurrent | ||||
| Expansive process | ||||
| Endoluminal obstruction | Airways compression | Others | ||
| 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 clots | Mediastinal 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 | ||