Stridor

Stridor is an abnormal, high-pitched sound that you can make when you breathe in or out. It happens when something is narrowing or blocking part of your airway. It can happen with blockages in your throat (pharynx), voice box (larynx) or windpipe (trachea). When it starts suddenly — especially in children — it needs medical care as soon as possible.

Stridor can happen to anyone at any age, but it’s more common in children because their airways are smaller. And because their airways are smaller, stridor can signal dangerous airway blockage or narrowing in young children and infants.

Types of stridor

There are three types of stridor. The type you have depends on the location of the blockage in your airway.

• Inspiratory: This type happens when you inhale. It happens because of extrathoracic blockages. That means outside of your chest (thorax), like in your throat or voice box.
• Expiratory: This type happens when you exhale. The blockages that cause it are intrathoracic (inside your chest), like in your windpipe.
• Biphasic (laryngomalacia or laryngeal stridor): This type happens when inhaling and exhaling. It happens because of narrowing at the level of your voice box in your throat.

What causes stridor?

Stridor happens when something interferes with airflow in your airway. It’s a similar effect to what happens when you whistle. To do that, you use your lips to make a narrower opening and blow. The narrowed opening and moving air are what make the sound. Stridor is the same effect, but somewhere in your throat or windpipe.

Stridor can be acute (new and short-term) or chronic (long-term). Some of the most common causes of stridor include:

• Upper respiratory infections like croup (the most common cause in children, accounting for about 90% of cases of stridor)
• Laryngomalacia (tissue softening that blocks your airway)
• Vocal cord dysfunction or paralysis
• Choking on a foreign object (foreign body aspiration)
• Injury to your airway
• Swelling (epiglottitis)

Other causes of stridor include:

• Allergic reactions, especially when they cause anaphylaxis
• A tumor, either benign (noncancerous) or malignant, like laryngeal cancer
• An abscess
• Smoke or chemical inhalation
• Neck surgery

Associated symptoms

Several symptoms commonly happen alongside stridor, and some of them signal danger. Some of the common, less dangerous symptoms include:

• Coughing
• Discomfort or pain when you swallow, or difficulty swallowing
• Fever
• Hoarseness
• Pain in your throat and/or neck
• Swelling in your throat and/or neck

Danger symptoms include:

• Any decrease in consciousness (how awake you are)
• Being unable to eat or drink
• Coughing up blood
• Difficulty breathing
• Drooling
• Pale, gray- or blue-tinged lips or fingertips/fingernails (cyanosis)

How doctors diagnose stridor

A healthcare provider can diagnose stridor using a combination of methods. They’ll start with a physical exam, including listening to your breathing with a stethoscope. They may also check to see if changing your baby’s position (like lying them on their back) affects stridor or other symptoms.

Your provider may also recommend tests, including:

• Laryngoscopy or bronchoscopy, where your provider uses a thin, flexible tool with a camera at the tip to see down your throat
• A pulse oximeter to check your blood oxygen levels
• Imaging tests, like a neck or chest X-ray or CT scan
• A blood gas test to check the oxygen and carbon dioxide levels in your blood

How is stridor treated?

Stridor is generally treatable, and many of its causes are manageable or even curable. If the blockage is from a small object, using choking first aid or the Heimlich maneuver may be enough to dislodge the blockage.

In many cases, no treatment is necessary. But if it is, a healthcare provider will first focus on stabilizing treatments as needed.

Emergency stabilizing treatments

When stridor happens because of a condition that threatens your ability to breathe, it’s a medical emergency. Providers will start with treatments that stabilize you and ensure you can keep breathing. These include:

• Heliox: This helium-oxygen mixture is easier to breathe than regular air.
• Intubation: Inserting a tube into your airway guarantees you can keep breathing.
• Cricothyrotomy or tracheostomy: These are surgery procedures that involve making a small opening near the base of your throat to let air directly into your windpipe. They’re an option when intubation isn’t possible.

Other treatments

You might need other treatments instead of or after emergency stabilizing treatments. They can include:

• Medications to reduce swelling (inflammation), treat infections or reduce pain
• Supplemental oxygen therapy
• Surgery to remove blockages or foreign objects, or to expand your airway
• Speech therapy or similar treatments

What can I expect if I have stridor?

Stridor means that your airway is narrower than it should be. And your airway is a critical structure that allows you to breathe. If you or your child has stridor that starts suddenly, they need medical care as soon as possible. If your child shows danger signs like trouble breathing, call 911 or your local emergency services number right away.

What you can expect from stridor depends on many factors. In general, quick diagnosis and treatment make a positive outcome more likely. Your healthcare provider is the best person to tell you more about what you can specifically expect in your case.

Can stridor be prevented?

Many causes of stridor are preventable. Some things you can do include:

• Supervise your child when they’re playing or eating.
• Chew your food completely before swallowing it.
• Keep small objects away from children or away from your mouth.
• Avoid secondhand smoke or other airborne irritants.
• Clean and sanitize frequently used surfaces and objects, like toys.
• Wash your hands with soap and water regularly.

Certain vaccinations can help prevent common infections that can cause stridor.

What questions should I ask my provider?

Some questions you might want to ask your provider include:

• What’s causing my (or my child’s) stridor?
• Is it treatable?
• What can I do to help myself (or my child)?
• Are there any symptoms or changes that mean I should call your office or get emergency medical care?