Stridor

What is stridor?

Stridor is the term used to describe noisy breathing which is produced by turbulent airflow through a narrowed segment of the airway. It typically originates from the larynx (voice box) or trachea (windpipe).

What are the causes of stridor?
Congenital problems of the airway, infectious conditions of the airway (croup), vocal cord paralysis, trauma and tumors of the airway can all cause stridor. Stridor is a sign of some type of problem and is not a diagnosis in itself. It should always be evaluated.

How is stridor evaluated?
Stridor is most appropriately evaluated by a pediatric otolaryngologist (ENT surgeon) who has special training and equipment for such evaluations. After obtaining a detailed history, your doctor may request certain imaging studies to help find the cause of the stridor. An ENT surgeon may also be able to pass a flexible scope through the nose or mouth to help evaluate the area. (flexible laryngoscopy) Often, it may be required to further evaluate the entire airway of a child under a general anesthetic to confirm initial findings and rule out lesions elsewhere in the respiratory tract. (Microlaryngoscopy and Bronchoscopy)

What is the most common cause of stridor in an infant?
Laryngomalacia is the most common cause of stridor in infants. It is the result of “floppy” laryngeal structures and tissues causing them to collapse into the airway. Laryngomalacia is the cause of stridor between 50% and 75% of infants. There are a number of characteristics of laryngomalacia that your doctor may ask you about.

Begins within the first few days of life or up to 2 months.
Tends to be louder with inspiration (breathing in)
Worse with crying, feeding and when infants are lying on their back
Tends to be better with infants in the prone position with the chin up.
May be accompanied by retractions (caving in of tissues above or below the ribs when breathing in)

The good news is that in most cases laryngomalacia is not very serious and does not require specific treatment. The noisy breathing starts to go away after 12-18 months of age. In some cases the laryngomalacia is more severe and can interfere with a child’s feeding, growth and development. Remember, there are serious problems which can cause the same symptoms as laryngomalacia so every case of stridor should be evaluated.