[Durgical](https://durgical.com/en/) › [DurgiPedia](https://durgical.com/en/durgipedia/) › [ENT](https://durgical.com/en/ent/) › [Throat and neck: approach to complaints](https://durgical.com/en/ent/areas/throat/) › Approach to stridor

# Approach to stridor

- Approach to a complaint

Stridor is a high-pitched breathing noise caused by a narrowed upper airway; it can be an emergency, above all in children.

Updated Nov 5, 2026

**See it in 3D:** [Epiglottis](https://durgical.com/en/anatomy/epiglottis/) · [Vocal folds](https://durgical.com/en/anatomy/vocal-fold/) · [Cricoid cartilage](https://durgical.com/en/anatomy/cricoid-cartilage/) · [Trachea](https://durgical.com/en/anatomy/trachea/)

## Key points

- Stridor = upper airway obstruction; in children it is more dangerous because the airway is narrower.
- Inspiratory: obstruction at or above the glottis; biphasic: subglottis or cervical trachea; expiratory: intrathoracic trachea or bronchi.
- Croup: child aged 3 months to 5 years, barking cough, hoarseness, worse at night; corticosteroid and, if moderate or severe, nebulised epinephrine.
- Epiglottitis: high fever, drooling, dysphagia, sitting and leaning forward; do not examine the throat with a tongue depressor.
- Sudden onset with choking in a young child without fever: foreign body until proven otherwise.
- Stridor at rest, or stridor that fades while breathing effort rises: a sign of severity.

## What it is

Stridor is a harsh, high-pitched breathing sound made by turbulent airflow through a narrowed upper airway: larynx, subglottis or trachea. It is not a diagnosis but a sign of obstruction, and it can be life-threatening. Young children are at higher risk because their airways are narrower. The first aim is to recognise severity and protect the airway; then the cause is sought from age, speed of onset, fever and associated symptoms. Stridor in infants (laryngomalacia and other congenital causes) is covered on the page on stridor in children.

## Key questions in the history

- Sudden onset (foreign body, anaphylaxis) or gradual (croup, tumour)?
- Fever and a toxic look? Drooling or trouble swallowing?
- Any choking while eating or playing with small objects?
- Exposure to allergens, stings or drugs; swelling of the face, lips or tongue?
- Previous intubation, neck surgery or tracheostomy?
- Vaccines up to date, especially Haemophilus influenzae type b and diphtheria?
- In adults: progressive hoarseness, smoking or weight loss?

## Causes and classification

- Infectious: croup (laryngotracheobronchitis), epiglottitis, bacterial tracheitis, diphtheria and pharyngeal abscesses.
- Foreign body in the larynx or trachea.
- Allergic: anaphylaxis and angioedema.
- Traumatic and iatrogenic: inhalation injury, prolonged intubation, neck surgery.
- Tumours: laryngeal cancer and recurrent respiratory papillomatosis.
- Neurological: bilateral vocal fold paralysis.
- Congenital in infants, such as laryngomalacia: see the page on stridor in children.

## Step-by-step approach

- Assess severity without upsetting the patient: colour, work of breathing, retractions, consciousness and oxygen saturation.
- Keep the child in the carer's arms and in the position the child prefers; do not force the child to lie down.
- Severe obstruction: oxygen, call the airway team and prepare for intubation or a surgical airway.
- Witnessed choking with an ineffective cough: age-appropriate airway clearance manoeuvres.
- High fever, drooling and a toxic look: manage as epiglottitis; secure the airway in theatre or ICU.
- Barking cough with low fever after a cold: croup; grade severity (for example with the Westley score).
- Urticaria, hypotension or swelling of the face or tongue: anaphylaxis; intramuscular epinephrine without delay.
- Stable patient: neck and chest X-ray, pulse oximetry, laryngoscopy or bronchoscopy as suspicion dictates.
- Adult with progressive stridor: laryngoscopy to rule out a tumour or vocal fold paralysis.

## Causes of acute stridor

| Cause | Typical age | Clues | Management |
| --- | --- | --- | --- |
| [Croup](https://durgical.com/en/conditions/croup/) | 3 months to 5 years | Barking cough, hoarseness, low fever, worse at night | Corticosteroid; nebulised epinephrine if moderate or severe |
| [Epiglottitis](https://durgical.com/en/conditions/acute-epiglottitis/) | Unvaccinated child or adult | High fever, drooling, dysphagia, leaning forward | Controlled airway in theatre or ICU; parenteral antibiotic |
| [Foreign body](https://durgical.com/en/conditions/foreign-body-aspiration-in-children/) | Infant and preschool child | Sudden choking, cough, no fever | Airway clearance; bronchoscopy |
| [Anaphylaxis or angioedema](https://durgical.com/en/conditions/anaphylaxis/) | Any age | Urticaria, swollen lips or tongue, hypotension | Intramuscular epinephrine |
| Bacterial tracheitis | Child | Toxic look after croup that gets worse | Hospital, antibiotic and airway management |
| [Papillomatosis or laryngeal tumour](https://durgical.com/en/conditions/laryngeal-cancer/) | Child (HPV) or adult smoker | Progressive hoarseness before the stridor | Laryngoscopy and referral to ENT |

## Red flags

- Stridor at rest, marked retractions or cyanosis.
- Drooling, inability to swallow or sitting leaning forward.
- Drowsiness or agitation: hypoxia or exhaustion.
- Stridor that fades while breathing effort rises: near-complete obstruction.
- Sudden onset after a choking episode.
- Infant under 6 months, or recurrent or persistent stridor.

## Next step / Initial management

- Mild croup: outpatient care with oral corticosteroid (dexamethasone) and warning signs; moderate or severe: nebulised epinephrine, oxygen and observation in the emergency department.
- Epiglottitis: do not examine the pharynx or do procedures that upset the patient; parenteral antibiotic and corticosteroid once the airway is secure.
- Anaphylaxis: immediate intramuscular epinephrine, oxygen and fluids.
- Refer urgently, with immediate accompanied transfer, any stridor at rest, epiglottitis, suspected foreign body or anaphylaxis.
- Chronic or recurrent stridor, or an adult with progressive hoarseness: priority referral to ENT for laryngoscopy.

## Test yourself

Think of the answer, then tap the question to see it.

## A 2-year-old has a barking cough, hoarseness and stridor that worsen at night after a cold. Diagnosis and management?

Viral croup, usually parainfluenza. Corticosteroid; if there is stridor at rest or moderate to severe distress, nebulised epinephrine and observation.

## An unvaccinated child has high fever, is drooling and sits leaning forward. What must you not do?

Do not examine the throat with a tongue depressor or upset the child: it may trigger complete obstruction. Suspect epiglottitis; secure the airway in theatre or ICU.

## What does stridor that fades while breathing effort rises mean?

Exhaustion and near-complete obstruction: a sign of severity, not improvement; intubation may be needed.

## An 18-month-old suddenly started coughing with stridor while eating peanuts, with no fever. What is the main suspicion?

A foreign body in the airway; it needs urgent assessment and bronchoscopy.

[Add to my cards (4)](https://durgical.app/estudiar/?add=/en/ent/approach-to-stridor/)

## Connections

## See it in 3D 4

The structures of Durgical's 3D anatomy where it is found.

- [Epiglottis](https://durgical.com/en/anatomy/epiglottis/)
- [Vocal folds](https://durgical.com/en/anatomy/vocal-fold/)
- [Cricoid cartilage](https://durgical.com/en/anatomy/cricoid-cartilage/)
- [Trachea](https://durgical.com/en/anatomy/trachea/)

## Related 5

- [Upper airway obstruction: recognition and first steps](https://durgical.com/en/ent/upper-airway-obstruction-recognition-and-first-steps/)
- [Stridor in infants and children](https://durgical.com/en/ent/stridor-in-infants-and-children/)
- [Foreign bodies in the airway and oesophagus, including button batteries](https://durgical.com/en/ent/foreign-bodies-in-the-airway-and-oesophagus-including-button-batteries/)
- [Emergency front-of-neck access: cricothyroidotomy and tracheostomy](https://durgical.com/en/ent/emergency-front-of-neck-access-cricothyroidotomy-and-tracheostomy/)
- [Mirror and flexible laryngoscopy](https://durgical.com/en/ent/mirror-and-flexible-laryngoscopy/)

## Related conditions 8

- [Croup (laryngotracheobronchitis)](https://durgical.com/en/conditions/croup/)
- [Acute epiglottitis](https://durgical.com/en/conditions/acute-epiglottitis/)
- [Foreign body aspiration in children](https://durgical.com/en/conditions/foreign-body-aspiration-in-children/)
- [Anaphylaxis](https://durgical.com/en/conditions/anaphylaxis/)
- [Urticaria and angioedema](https://durgical.com/en/conditions/urticaria-and-angioedema/)
- [Diphtheria](https://durgical.com/en/conditions/diphtheria/)
- [Laryngeal cancer](https://durgical.com/en/conditions/laryngeal-cancer/)
- [Vocal fold paralysis (recurrent laryngeal nerve injury)](https://durgical.com/en/conditions/vocal-fold-paralysis/)

## In Pharmacology 3

- [Dexamethasone](https://durgical.com/en/pharmacology/dexamethasone/)
- [Epinephrine](https://durgical.com/en/pharmacology/epinephrine/)
- [Corticosteroids (glucocorticoids)](https://durgical.com/en/pharmacology/classes/corticosteroids/)

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Educational content; it does not replace a medical assessment and is not a clinical instruction. For a real case, follow current guidelines and specialist advice.

Sources: [Stridor (MedlinePlus Medical Encyclopedia)](https://medlineplus.gov/ency/article/003074.htm) (U.S. National Library of Medicine, NIH, 2026); [Croup (MedlinePlus Medical Encyclopedia)](https://medlineplus.gov/ency/article/000959.htm) (U.S. National Library of Medicine, NIH, 2026); [Epiglottitis (MedlinePlus Medical Encyclopedia)](https://medlineplus.gov/ency/article/000605.htm) (U.S. National Library of Medicine, NIH, 2026); [Recurrent Respiratory Papillomatosis or Laryngeal Papillomatosis](https://www.nidcd.nih.gov/health/recurrent-respiratory-papillomatosis) (National Institute on Deafness and Other Communication Disorders (NIDCD), NIH, 2017).

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Representative model, for educational purposes only.

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Source: https://durgical.com/en/ent/approach-to-stridor/
License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/ent/approach-to-stridor/