EN4.43 | Stridor — Summary & Reflection

KEY TAKEAWAYS

Stridor is a sign of partial airway obstruction. The phase localises the level: inspiratory = supraglottis/glottis; biphasic = subglottis/trachea; expiratory = intrathoracic. Age group drives the differential: infants — laryngomalacia (commonest; inspiratory, feeding-triggered, omega-shaped epiglottis on FFNL, self-resolves by 18-24 months; surgery only for failure to thrive/apnoea); children — croup (parainfluenza, barking cough, steeple sign, dexamethasone ± nebulised adrenaline) and epiglottitis (H. influenzae, drooling, thumb sign, DO NOT examine throat, secure airway first); adults — bilateral VCP (post-thyroidectomy, biphasic stridor, voice preserved, tracheostomy), post-intubation subglottic stenosis (Cotton-Myer grading, endoscopic dilatation or laryngotracheal reconstruction), laryngeal carcinoma. Severity assessment: SpO2, work of breathing, stridor at rest vs exertion, mental status. Immediate management hierarchy: position → oxygen → nebulised adrenaline (croup) → corticosteroids → intubation → tracheostomy → cricothyroidotomy (emergency). A silent chest in a distressed child is a pre-arrest sign, NOT improvement.

REFLECT

Laryngomalacia is the commonest cause of infant stridor in India, and it resolves spontaneously in the vast majority of cases — yet parents of a baby with stridor are often terrified by the noise. The baby that wheezes with every feed looks, to an anxious mother, as though it is struggling for life. Reflect on how you would counsel such a parent: what information would you give, what would you ask them to watch for, and how would you balance the reassurance they need with the safety-netting they require? Now contrast that with the adult scenario: a 58-year-old man in your rural clinic has been hoarse for eight weeks and now has mild exertional stridor. He has not sought care earlier because he assumed it was a 'throat problem.' What does his delay represent — and what specific warning signs would you look for on examination that would make you expedite an emergency referral rather than a routine ENT appointment?