Stridor &

Stertor
By
Dr. Baseem N. Abdulhadi

Definitions:
Stridor: it is a harsh, high-pitched, almost

musical sound, caused by vibration of

partially obstructing soft tissue in the larynx
or upper trachea.
Stertor: it is rough noisy breathing, similar to

snoring, caused by vibration of partially

obstructing soft tissues in the pharynx.
Wheeze: is a high-pitched husky or whistling

sound, caused by narrowing of soft tissue in

the intrathoracic airways.

Stridor
Inspiratory Stridor
It

occurs during inspiration only, often a

crowning sound, and is due to obstruction at the
glottis, supraglottis or subglottis level.

Expiratory Stridor
It occurs during expiration only, usually at a

slightly lower pitch than inspiratory stridor, and

is due to obstruction of the subglottis or
extrathoracic trachea.
Biphasic Stridor
It involves both inspiration and expiration, and,

while representing laryngeal obstruction, is a

hallmark of severe obstruction.

Bernoulli's principle

Stridor: history taking

Age of onset, duration, severity, and progression;

precipitating events (e.g. crying, feeding);

positioning (eg, prone, supine, sitting); quality and
nature of crying; presence of aphonia; and other
associated symptoms (eg, paroxysms of cough,
aspiration, difficulty feeding, drooling, sleep
disordered breathing).

Perinatal

history - maternal condylomata,

endotracheal intubation use and duration, and
presence of congenital anomalies .

Feeding

history.

and

growth

history,

developmental

Stridor : Examination
Heart

and respiratory rates, cyanosis, use of

accessory muscles of respiration, nasal flaring, level
of consciousness, and responsiveness.

Note the presence of infection in the oral cavity;

crepitations or masses in the soft tissues of the face,

neck, or chest; and deviation of the trachea

Use care when examining (especially palpating) the

oral
cavity
or
pharynx
because
sudden
dislodgement of a foreign body or rupture of an
abscess can cause further airway compromise.

Stridor : Examination
Drooling from the mouth - suggests poor handling

of secretions, Dysphagia.

Observe the character of the cough, cry, and

voice.

Careful

auscultation of the nose, oropharynx,

neck, and chest helps to discern the location of
the stridor.

Special

attention to craniofacial morphology,

patency
of
the
nares,
and
cutaneous
hemangiomas.

CAUSES: Acute Onset Stridor

1. Laryngotracheobronchitis (croup)
the most common cause of acute stridor in children
6 months to 2 years
barking cough that is worst at night
low-grade fever
2. Aspiration of foreign body
1-2 years
food such as nuts, hot dogs, popcorn, and hard candy
history of coughing and choking that precedes
development of respiratory symptoms
3. Bacterial tracheitis
uncommon
younger than 3 years
secondary
infection
(most
commonly
due
to
Staphylococcus aureus) following a viral process
(commonly croup or influenza)

CAUSES: Acute Onset Stridor

4. Retropharyngeal abscess
complication of bacterial pharyngitis
younger than 6 years
abrupt onset of high fevers, difficulty swallowing,
refusal to feed, sore throat, hyperextension of the
neck, and respiratory distress
5. Peritonsillar abscess
infection in the potential space between the superior
constrictor muscles and the tonsil
common in adolescents and preadolescents.
patient develops severe throat pain and trouble
swallowing or speaking

CAUSES: Acute Onset Stridor

6. Spasmodic croup (acute spasmodic laryngitis)
most commonly in children aged 1-3 years
presentation may be identical to croup
7. Allergic reaction (ie, anaphylaxis)
hoarseness and inspiratory stridor may be accompanied by
symptoms (eg, dysphagia, nasal congestion, itching eyes,
sneezing, wheezing) that indicate the involvement of other
organs
8. Epiglottitis
medical emergency
most commonly in children aged 2-7 years
Clinically, the patient experiences an abrupt onset of highgrade fever, sore throat, dysphagia, and drooling

CAUSES: Chronic Stridor

1) Laryngomalacia:
It is the most common laryngeal anomaly
It is the most common cause of stridor in neonate and
chronic pediatric stridor
Clinical presentation:

Intermittent inspiratory stridor that improves in

prone position; worse with feeding, crying, or in
supine position; presents within weeks of birth; normal
voice; usually self-limiting as cartilage stiffens with growth
(around 2 years of age)

Most Common Laryngeal Findings

1. inward collapse of AE folds and cuneiform
cartilage into laryngeal inlet during
inspiration
2. epiglottis is tall, tubular and omega
shaped; collapses into laryngeal inlet
3. short AE folds, tight, and bulky
Dx: clinical history and endoscopy
Rx: observation (typically resolves with
growth), epiglottoplasty (removes excess
tissue), correct GERD if present, rarely

2) Subglottic stenosis
inspiratory or biphasic stridor

Congenital:

incomplete

canalization

of

the

subglottis and cricoid rings.

Acquired: is most commonly caused by prolonged
intubation.

3) Vocal cord dysfunction:

Unilateral vocal cord paralysis: congenital or secondary
to trauma at birth or time of cardiac or intrathoracic
surgery
Bilateral vocal cord paralysis: Pt present with aphonia
and a high-pitched stridor that may progress to severe
respiratory distress.

Thank
you