Symptoms
A high-pitched, whistling or squeaking sound when breathing, especially when inhaling.
Difficulty breathing.
Retractions (pulling in of the skin around the ribs or neck with each breath).
Hoarseness.
Coughing.
Bluish skin color (cyanosis) if oxygen levels are low.
Nasal flaring.
Anxiety or agitation due to difficulty breathing.
Causes
Infections: Croup, epiglottitis, tonsillitis, peritonsillar abscess, retropharyngeal abscess.
Foreign body aspiration: Swallowing an object that becomes lodged in the airway.
Allergic reactions: Anaphylaxis, angioedema.
Swelling: From injury or surgery.
Tumors or growths in the airway.
Vocal cord paralysis or dysfunction.
Subglottic stenosis: Narrowing of the airway below the vocal cords.
Laryngomalacia: Softening of the tissues of the larynx (more common in infants).
Tracheomalacia: Softening of the trachea.
Medicine Used
The medications used to treat stridor depend entirely on the underlying cause. Examples include:
Corticosteroids: To reduce inflammation in conditions like croup. Examples include dexamethasone or prednisolone.
Epinephrine (racemic epinephrine): Used to reduce swelling in the airway in severe cases of croup.
Antibiotics: To treat bacterial infections like epiglottitis or bacterial tracheitis.
Antihistamines and/or epinephrine: Used to treat allergic reactions causing airway swelling.
Bronchodilators: May be used if there is a reactive airway component.
Is Communicable
? Stridor itself is not communicable. However, some of the underlying causes of stridor, such as viral or bacterial infections (e.g., croup, epiglottitis), can be communicable.
Precautions
Precautions depend on the underlying cause of the stridor.
For infectious causes: Good hand hygiene, avoiding close contact with infected individuals, and vaccination (e.g., Hib vaccine to prevent epiglottitis).
For allergic reactions: Avoiding known allergens, carrying an epinephrine auto-injector (EpiPen) if prescribed, and wearing a medical alert bracelet.
For foreign body aspiration: Keeping small objects out of reach of young children, supervising children while eating, and learning the Heimlich maneuver.
General: Seek immediate medical attention if stridor develops, especially if accompanied by difficulty breathing or bluish skin.
How long does an outbreak last?
Stridor is not an outbreak. It's a symptom. The duration of the underlying condition causing the stridor varies. For example:
Croup: Symptoms typically last 3-7 days.
Epiglottitis: Is an acute medical emergency that requires prompt treatment and does not have an "outbreak" duration in the same sense as a viral illness.
Allergic reaction: Symptoms can resolve quickly with treatment, or persist if exposure to the allergen continues.
How is it diagnosed?
Physical exam: Listening to the breathing sounds with a stethoscope.
Medical history: Asking about symptoms, allergies, and possible exposures.
Pulse oximetry: To measure oxygen saturation levels.
Chest X-ray or neck X-ray: To visualize the airway and lungs.
Laryngoscopy or bronchoscopy: Using a flexible tube with a camera to directly visualize the larynx and trachea.
Blood tests: To look for signs of infection.
Allergy testing: If an allergic reaction is suspected.
Timeline of Symptoms
The timeline of symptoms depends on the underlying cause:
Croup: Often starts with cold-like symptoms (runny nose, cough) for a few days, followed by the development of stridor, barking cough, and hoarseness. Symptoms are often worse at night.
Epiglottitis: Sudden onset of high fever, sore throat, difficulty swallowing, drooling, and stridor.
Foreign body aspiration: Sudden onset of choking, coughing, gagging, and stridor.
Allergic reaction: Rapid onset of symptoms, including stridor, hives, swelling, and difficulty breathing after exposure to an allergen.
Important Considerations
Stridor is a sign of airway obstruction and can be life-threatening. Prompt medical evaluation is essential.
The treatment for stridor depends on the underlying cause.
Children are more vulnerable to airway obstruction due to their smaller airways.
Never attempt to remove a foreign object from the airway yourself unless you are trained in first aid.
If you suspect an allergic reaction, administer epinephrine (if prescribed) and call emergency services immediately.
Avoid agitating a child with suspected epiglottitis, as this can worsen the airway obstruction. Keep the child calm and transport them to the hospital as quickly as possible.