Stridor is a harsh sound heard during inspiration when there is narrowing of the upper airways, including oropharynx, subglottis, larynx, and trachea.
Conditions presenting with stridor include:
- Viral croup including that due to measles
- Retropharyngeal abscess
- Foreign body inhalation
- Pressure on the airways by masses in the neck or mediastinum
- Congenital laryngeal anomaly
- Viral croup: Barking cough, hoarse voice, respiratory distress if obstruction is severe (tachypnoea, supraclavicular, suprasternal, subcostal and intercostal inspiratory retractions, cyanosis). Fever in 50% of children. Signs of measles if it is the cause.
- Retropharyngeal abscess: Swelling in the neck, difficulty in swallowing, drooling, fever.
- Foreign body: History of choking, sudden onset of respiratory distress.
- Diphtheria: Severe neck swelling, membrane on throat and tonsils.
- Congenital anomaly: Stridor from birth.
- Pressure on airways: Obvious masses in neck or mediastinum on x-ray.
- Mild croup can be treated at home. Encourage adequate intake of fluids and feeding according to age.
- Ask the mother to bring child back immediately she notices difficulty in breathing or feeding
- Foreign body: This may be life threatening if main airway is blocked. Action should be immediate if the child is to survive.
- Severe cases will need care in an intensive care unit:
- Be prepared for intubation and/or tracheostomy
- Administer O2
- Nasotracheal intubation if signs of severe obstruction occur: Severe chest indrawing, agitation, anxiety (air-hunger) and cyanosis
- Tracheostomy may be done if intubation is impossible.