Stridor Treatment & Management
- Author: Brian E Benson, MD; Chief Editor: Ravindhra G Elluru, MD, PhD more...
The treatment of stridor must be tailored according to the particular underlying or predisposing condition present (see Etiology). Emergency management consists of ensuring that the airway is adequate. If it is not, appropriate resuscitative measures must be initiated. For some conditions (eg, epiglottitis and bacterial tracheitis), antibiotic therapy may be required, whereas in other scenarios, steroid therapy may be useful.[19, 20]
For certain conditions, such as the following, surgical correction is required:
- Severe laryngomalacia
- Laryngeal stenosis
- Critical tracheal stenosis
- Laryngeal and tracheal tumors and lesions (eg, laryngeal papillomas and hemangiomas)
- Foreign body aspiration
Occasionally, tracheotomy is used to protect the airway to bypass laryngeal abnormalities and stent or bypass tracheal abnormalities. Other conditions, such as retropharyngeal and peritonsillar abscess, may have to be dealt with on an emergency basis.
Patients with moderate to severe stridor should be given nothing by mouth (nil per os [NPO]) in preparation for possible intubation, laryngoscopy, bronchoscopy, and tracheotomy.
Close clinical follow-up is important, especially in patients with congenital anomalies (eg, laryngomalacia, laryngeal webs, and vocal cord paresis), to follow disease progression.
Cotton RT, Reilly JS. Stridor and airway obstruction. Bluestone C, Stool S, Kenna M, eds. Pediatric Otolaryngology. 3rd ed. Philadelphia, PA: WB Saunders Co; 1995. 1275-86.
Behrman RE, Kliegman RM, Jenson HB, eds. Nelson Textbook of Pediatrics. Philadelphia, PA: WB Saunders; 1996.
Bailey BJ, Calhoun KH, Healy GB, eds. Head & Neck Surgery - Otolaryngology. 3rd ed. Philadelphia, PA: Lippincott, Williams, & Wilkins; 2001.
Geelhoed GC. Croup. Pediatr Pulmonol. 1997 May. 23(5):370-4. [Medline].
Klassen TP. Croup. A current perspective. Pediatr Clin North Am. 1999 Dec. 46(6):1167-78. [Medline].
Bent J. Pediatric laryngotracheal obstruction: current perspectives on stridor. Laryngoscope. 2006 Jul. 116(7):1059-70. [Medline].
Lalakea M, Messner AH. Retropharyngeal abscess management in children: current practices. Otolaryngol Head Neck Surg. 1999 Oct. 121(4):398-405. [Medline].
Mancuso RF. Stridor in neonates. Pediatr Clin North Am. 1996 Dec. 43(6):1339-56. [Medline].
Ambrosio A, Brigger MT. Pediatric supraglottoplasty. Adv Otorhinolaryngol. 2012. 73:101-4. [Medline].
Digoy GP, Burge SD. Laryngomalacia in the older child: clinical presentations and management. Curr Opin Otolaryngol Head Neck Surg. 2014 Dec. 22(6):501-5. [Medline].
Amir M, Youssef T. Congenital glottic web: management and anatomical observation. Clin Respir J. 2010 Oct. 4(4):202-7. [Medline].
Denoyelle F, Garabédian EN. Propranolol may become first-line treatment in obstructive subglottic infantile hemangiomas. Otolaryngol Head Neck Surg. 2010 Mar. 142(3):463-4. [Medline].
Mikolajczak S, Quante G, Weissenborn S, et al. The impact of cidofovir treatment on viral loads in adult recurrent respiratory papillomatosis. Eur Arch Otorhinolaryngol. 2012 Jul 6. [Medline].
Tan HKK, Holinger LD. How to evaluate and manage stridor in children. J Respir Dis. 1994. 15(3):245-260.
Pryor MP. Noisy breathing in children: history and presentation hold many clues to the cause. Postgrad Med. 1997 Feb. 101(2):103-12. [Medline].
Avari S. Management of laryngomalacia. Eur Ann Otorhinolaryngol Head Neck Dis. 2012 Jul 24.
Carpes LF, Kozak FK, Leblanc JG, et al. Assessment of vocal fold mobility before and after cardiothoracic surgery in children. Arch Otolaryngol Head Neck Surg. 2011 Jun. 137(6):571-5. [Medline].
Thompson DM. Laryngomalacia: factors that influence disease severity and outcomes of management. Curr Opin Otolaryngol Head Neck Surg. 2010 Dec. 18(6):564-70. [Medline].
Khemani RG, Randolph A, Markovitz B. Corticosteroids for the prevention and treatment of post-extubation stridor in neonates, children and adults. Cochrane Database Syst Rev. 2009 Jul 8. CD001000. [Medline].
Phillips BA. Corticosteroids in respiratory diseases in children. Am J Respir Crit Care Med. 2012 Jun 15. 185(12):1328-9. [Medline].
Natt RS, Helliwell T, McCormick M. Tracheopathia chondro-osteoplastica--an unusual cause of stridor. J Laryngol Otol. 2009 Sep. 123(9):1039-41. [Medline].