The following symptoms and complaints may indicate Stridor:
Leading symptom
- Whistling respiratory sound (whistling breathing) that occurs during inspiration and/or expiration (inspiratory/expiratory stridor)
Stridor can be differentiated according to its localization:
- Stridor nasalis – mostly audible as “sniffing”.
- Stridor pharyngealis – mostly audible as “snoring“.
- Stridor laryngealis – mostly audible as “whistling”.
- Stridor trachealis – mostly audible as “humming”.
Cave (Attention)!
- Immediate hospitalization if the following symptoms also occur: Child with increased pulse and increased respiratory rate with increasing intercostal (“between the ribs“) retractions, possibly also signs of drowsiness.
Note: In inspiratory stridor (breathing sound on inspiration), the main distinction is between:
- viral croup (formerly: pseudocroup): laryngitis (inflammation of the larynx), which leads mainly to swelling of the mucosa below the vocal cords (stenosing laryngitis); this is usually manageable without invasive measures; DD (differential diagnoses; diseases with similar or almost identical symptoms): Tracheitis(tracheitis), diphtheria; symptoms and complaints that may indicate pseudocroup:
- Acute onset of hoarseness (dysphonia), barking cough, and inspiratory stridor (predominantly at night).
- Occasional fever (< 38.5 °C).
- Usually only mild dyspnea (shortness of breath); transition to a severe course with pronounced dyspnea is possible
- Occasionally restlessness, anxiety
- Epiglottitis (epiglottitis): laryngitis supraglottica: Acute, purulent inflammation of the epiglottis, occurring almost exclusively in infants, due to infection with Haemophilus influenzae type b (Hib) (made rare by Hib vaccination); acute emergency requiring rapid hospitalization for intubation (insertion of a tube (hollow probe) through the mouth or nose between the vocal folds of the larynx into the trachea) (leads to death in 24-48 hours if untreated! ); DD: Retropharyngeal abscess: collection of pus (abscess) in the spatium retropharyngeum (retropharyngeal space/area between the posterior pharyngeal wall and the spine), angina, tracheitis, EBV infection; the following symptoms must be concerning:
- Child sits bent forward with mouth open.
- Dysphagia (difficulty swallowing) and severe pain
- Aphonia (voicelessness; disturbances in the formation of sound up to the loss of voice).
- Pronounced salivation
- High fever (> 39 °C)
- Cherry-red, balloon-like distended epiglottis (per laryngoscopy/throatoscopy).
Warning signs (red flags) in children
- Medical history:
- Sudden onset without evidence of respiratory infection → think of: Foreign body aspiration (inhalation of a foreign body).
- High fever + low-frequency stridor + dysphagia (dysphagia) → think of: Epiglottis (inflammation of the epiglottis) Caveat. Pharyngeal examination may provoke airway obstruction.
- Inspiratory stridor + acute dyspnea → think of: Upper airway obstruction (dyspnea may increase to asphyxia (impending asphyxia); retractions in the jugulum (small depression in the front of the neck) and epigastrium (abdominal region between the costal arch and the navel) and increasing cyanosis).
- Expiratory stridor + acute dyspnea → think of: Bronchospasm (cramping of the muscles surrounding the airways); if in addition skin symptoms (redness, wheals, etc.), hypotension (drop in blood pressure) and tachycardia (heartbeat too fast: > 100 beats per minute) → think of: anaphylactic reaction