Stridor

Did You Know?

• Stridor is different from stertor, which is a snoring noise from the pharynx, and wheezing, which originates in the bronchi.
• Flexible fiberoptic bronchoscopy can assess vocal cord function or look for signs of compression or infection.
• Chest and neck x-rays, bronchoscopy, CT-scans, and MRIs may reveal structural pathology.

Treatments

The first clinical concern in stridor is whether tracheal intubation or tracheostomy is immediately necessary. A reduction in oxygen saturation is a late sign of airway obstruction, especially in children with healthy lungs. Some patients require immediate tracheal intubation; if delay is possible, other options may be considered. Expectant management includes full monitoring, oxygen by face mask, and positioning the head at 45 to 90 degrees. Nebulized racemic epinephrine (0.5 to 0.75 ml of 2.25% solution in 2.5 to 3 ml normal saline) can be used for airway edema; nebulized codeine (not exceeding 3 mg/kg) may also be used but not together with racemic adrenaline due to risk of ventricular arrhythmias. Dexamethasone 4–8 mg IV every 8 to 12 hours may help edema, though full effect takes hours. Inhaled Heliox (70% helium, 30% oxygen) reduces turbulent flow almost instantly. In obese patients, elevation of the panniculus relieves symptoms by 80%.