Breathing sounds - abnormal (stridor)

Definition:

An abnormal, high-pitched, musical breathing sound caused by a blockage in the throat or larynx (extrathoracic airway obstruction); usually heard when inhaling. Also, see wheezing and abnormal lung sounds. Stridor may indicate an emergency and should always be evaluated immediately by a health care provider.

Alternative Names:

Stridor

Considerations:

Children are at higher risk of airway obstruction because they have narrower airways than adults. In young children, stridor is a significant sign of airway obstruction and must be treated immediately in order to prevent total airway obstruction.

The airway can be obstructed by an object, by swelling of the tissues of the throat or upper airway, or by spasm of the airway muscles or the vocal cords.

Common Causes:

inhalation of an object such as a peanut or marble (foreign body aspiration)
laryngitis (acute)
airway trauma
allergic reaction
croup
enlarged tonsils or adenoids (such as with tonsillitis)
abscess on the tonsils
inhalation injury (such as smoke inhalation)
neck surgery
neck or face swelling
secretions, particularly phlegm (sputum)
vocal cord cancer
prolonged intubation (breathing tube)
diagnostic tests such as bronchoscopy or laryngoscopy

Home Care:

Follow prescribed therapy in treating the underlying cause. See also first-aid measures for choking.

Call your health care provider if:

there is any indication of unexplained stridor, especially in a child.

What to expect at your health care provider's office:

In emergency situations, vital signs (temperature, pulse, rate of breathing, blood pressure) will be monitored, and the Heimlich maneuver may be necessary. Then the medical history will be obtained, and a physical examination performed. Intubation (insertion of a "breathing tube") may be necessary if there is inability to breathe properly (respiratory failure).

Medical history questions documenting abnormal breathing sounds in detail may include:

quality
- Is the abnormal breathing sounds a high-pitched sound?
time pattern
- Did it begin suddenly?
aggravating factors
- Is it possible that the child may have put something in his (her) mouth and gotten it into their windpipe?
- Has the child been ill recently?
other
- Is the child's neck or face swollen?
- Has the child been coughing or complaining of a sore throat?
- What other symptoms are also present?
- Is there nasal flaring?
- Is the child using their chest muscles to breathe (intercostal retractions)?
- Does the child have blue lips, blue nailbeds, or bluish color of the skin?

The physical examination will include monitoring the vital signs and listening to the lungs.

Diagnostic tests that may be performed include:

arterial blood gas analysis
bronchoscopy (using a scope to look directly at the airway)
CT scan, thoracic
laryngoscopy
X-ray of the chest

After seeing your health care provider:
You may want to add a diagnosis related to stridor to your personal medical record.

Review Date: 12/10/2001
Reviewed By: Jonathan Fanaroff, M.D., Department of Pediatrics, Rainbow Babies and Children's Hospital, Case Western Reserve University, Cleveland, OH. Review provided by VeriMed Healthcare Network.

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