WordNet

a whistling sound when breathing (usually heard on inspiration); indicates obstruction of the trachea or larynx
of or relating to the breathing out phase of respiration

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(肺から)息を吐く,呼気の

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出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2017/05/30 13:16:09」(JST)

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Stridor

Inspiratory and expiratory stridor in a 13-month child with croup.

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Stridor (Latin for "creaking or grating noise") is a high-pitched breath sound resulting from turbulent air flow in the larynx or lower in the bronchial tree. It should not be confused with stertor which is a noise originating in the pharynx. Stridor is a physical sign which is caused by a narrowed or obstructed airway. It can be inspiratory, expiratory or biphasic, although it is usually heard during inspiration. Inspiratory stridor often occurs in children with croup. It may be indicative of serious airway obstruction from severe conditions such as epiglottitis, a foreign body lodged in the airway, or a laryngeal tumor. Stridor should always command attention to establish its cause. Visualization of the airway by medical experts equipped to control the airway may be needed.

Causes

Stridor may occur as a result of:

Foreign bodies (e.g., aspirated foreign body, aspirated food bolus);
Tumor (e.g., laryngeal papillomatosis, squamous cell carcinoma of larynx, trachea or esophagus);
ALL (T-cell ALL can present with mediastinal mass that compresses the trachea and causes inspiratory stridor);
Infections (e.g., epiglottitis, retropharyngeal abscess, croup);
Subglottic stenosis (e.g., following prolonged intubation or congenital);
Airway edema (e.g., following instrumentation of the airway, tracheal intubation, drug side effect, allergic reaction);
Laryngospasm (from aspiration, GERD, or complication of anesthesia)
Subglottic hemangioma (rare);
Vascular rings compressing the trachea;
Many thyroiditis such as Riedel's thyroiditis;
Vocal cord palsy;
Tracheomalacia or Tracheobronchomalacia (e.g., collapsed trachea).
Congenital anomalies of the airway are present in 87% of all cases of stridor in infants and children.^[1]
Vasculitis.
infectious mononucleosis
peritonsillar abscess

Diagnosis

Stridor is mainly diagnosed on the basis of history and physical examination, with a view to revealing the underlying problem or condition.

Chest and neck x-rays, bronchoscopy, CT-scans, and/or MRIs may reveal structural pathology.

Flexible fiberoptic bronchoscopy can also be very helpful, especially in assessing vocal cord function or in looking for signs of compression or infection.

Treatments

The first issue of clinical concern in the setting of stridor is whether or not tracheal intubation or tracheostomy is immediately necessary. A reduction in oxygen saturation is considered a late sign of airway obstruction, particularly in a child with healthy lungs and normal gas exchange. Some patients will need immediate tracheal intubation. If intubation can be delayed for a period, a number of other potential options can be considered, depending on the severity of the situation and other clinical details. These include:

Expectant management with full monitoring, oxygen by face mask, and positioning the head on the bed for optimum conditions (e.g., 45 - 90 degrees).
Use of nebulized racemic adrenaline epinephrine (0.5 to 0.75 ml of 2.25% racemic epinephrine added to 2.5 to 3 ml of normal saline) in cases where airway edema may be the cause of the stridor. (Nebulized Codeine in a dose not exceeding 3 mg/kg may also be used, but not together with racemic adrenaline [because of the risk of ventricular arrhythmias].)
Use of dexamethasone (Decadron) 4–8 mg IV q 8 - 12 h in cases where airway edema may be the cause of the stridor; note that some time (in the range of hours) may be needed for dexamethasone to work fully.
Use of inhaled Heliox (70% helium, 30% oxygen); the effect is almost instantaneous. Helium, being a less dense gas than nitrogen, reduces turbulent flow through the airways. Always ensure an open airway.

In obese patients elevation of the panniculus has shown to relieve symptoms by 80%.

References

^ Holinger LD (1980). "Etiology of stridor in the neonate, infant and child". Ann. Otol. Rhinol. Laryngol. 89 (5 Pt 1): 397–400. PMID 7436240.

External links

Audio Breath Sounds - Multiple case studies with audio files of lung sounds.

Stridor at eMedicine
Congenital stridor at eMedicine
MedlinePlus Encyclopedia Breathing sounds - abnormal (stridor)
DDB 27190

Stridor sounds at R.A.L.E. Lung Sounds

UpToDate Contents

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1. 小児における吸気時喘鳴の評価 assessment of stridor in children
2. 成人における喘息以外の喘鳴をきたす疾患の評価 evaluation of wheezing illnesses other than asthma in adults
3. 成人における気管軟化症および気管気管支軟化症 tracheomalacia and tracheobronchomalacia in adults
4. 緩和ケア：咳嗽、上気道性喘鳴、および喀血の概要 palliative care overview of cough stridor and hemoptysis
5. アナフィラキシー：急性期診断 anaphylaxis acute diagnosis

English Journal

Prediction of airway inflammation in patients with asymptomatic asthma by using lung sound analysis.

Shimoda T1, Nagasaka Y2, Obase Y3, Kishikawa R4, Iwanaga T4.
The journal of allergy and clinical immunology. In practice.J Allergy Clin Immunol Pract.2014 Nov-Dec;2(6):727-732.e1. doi: 10.1016/j.jaip.2014.06.017. Epub 2014 Oct 5.
BACKGROUND: The intensity and frequency of sounds in a lung sound analysis (LSA) may be related to airway constriction; however, whether any factors of an LSA can predict airway eosinophilic inflammation in patients with asthma is unknown.OBJECTIVE: To determine whether an LSA can predict airway eos
PMID 25439364

Validation of computerized wheeze detection in young infants during the first months of life.

Puder LC, Fischer HS, Wilitzki S, Usemann J, Godfrey S, Schmalisch G1.
BMC pediatrics.BMC Pediatr.2014 Oct 9;14:257. doi: 10.1186/1471-2431-14-257.
BACKGROUND: Several respiratory diseases are associated with specific respiratory sounds. In contrast to auscultation, computerized lung sound analysis is objective and can be performed continuously over an extended period. Moreover, audio recordings can be stored. Computerized lung sounds have rare
PMID 25296955

Utility of preoperative anesthesia clinic videoendoscopy for airway management planning.

Kallio PJ1, Cox AE1, Pagel PS1.
Anesthesiology and pain medicine.Anesth Pain Med.2014 Sep 1;4(4):e19776. doi: 10.5812/aapm.19776. eCollection 2014.
INTRODUCTION: The authors performed videolaryngoscopy during the preoperative anesthesia clinic evaluation of a patient with chronic dyspnea, stridor, and a previous hemilaryngectomy scheduled to undergo a series of orthopedic surgery procedures for an infected knee arthroplasty. The findings proved
PMID 25337475

Japanese Journal

突然の呼吸困難を来たした脳梗塞患者 : 両側声帯麻痺の 1 例

松宮晴子,永井厚志,金野公郎,林光俊
気管支学 : 日本気管支研究会雑誌 15(3), 299-302, 1993-05-25
脳梗塞患者にみられた両側声帯麻痺の1例を経験した。症例は71歳, 男性。脳梗塞の加療中突然喘鳴を伴った呼吸困難に陥った。当初気管支喘息の治療を行っていたが改善なく, 吸気の延長もみられることから上気道閉塞を疑い, 気管支鏡を施行し両側声帯麻痺と判明した。本疾患は窒息の危険性があるため, 吸気の延長と喘鳴を認めた場合は気管支鏡による可及的診断が必要であると思われた。
NAID 110002817911

慢性呼吸不全を呈した両側反回神経麻痺の 1 例

渡辺東,小川裕,後藤厚,野本日出男,武井伸夫,溝部政史,浦田誓夫,真野健次
気管支学 : 日本気管支研究会雑誌 11(3), 301-305, 1989-06-10
… 聴診上両側肺野と頸部にstridorと呼気性の乾性ラ音を聴取した。 …
NAID 110004086372

選択性α_2受容体拮抗薬の難治性喘息に対する改善効果

吉江康正,飯塚邦彦,梅枝愛郎,小林節雄,中沢次夫
アレルギー 36(7), 413-416, 1987-07-30
難治性喘息患者に対し, 選択性α_2受容体遮断剤である2-〔2-(4, 5-dihydro-1H-imidazol-2-yl)-1-phenylethyl〕pyridine dihydrochloride sesquihydrate (DG-5128) 200mgを経口投与(頓用)し, 肺機能と症状の改善効果を検討した.対象は難治性喘息で喘鳴が持続している患者10名とし, DG-5128を服用後1 …
NAID 110002414887

「呼気性喘鳴」

Stridor
Classification and external resources
Specialty	Otorhinolaryngology, pediatrics
ICD-10	R06.1
ICD-9-CM	786.1
MedlinePlus	003074
Patient UK	Stridor
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