Noisy Breathing/Stridor

Noisy breathing is common in children, and can be a sign of many different conditions, some of which are very benign and some of which require urgent treatment.

What is Noisy Breathing?

Noisy breathing is typically caused by a partial blockage or narrowing at some point in the airways (respiratory tract). This can occur in the mouth or nose, in the throat, in the larynx (voice box), in the trachea (breathing tube) or further down into the lungs. It is created by turbulent or irregular airflow caused by the narrowed airway. This can cause the surrounding tissues to collapse, or can be a single fixed point of narrowing.

What are Some Types of Noisy Breathing?

  • Stertor is typically low-pitched and most closely sounds like nasal congestion experienced with a cold, or like the sound made with snoring. This noise is created in the nose or the back of the throat.
  • Stridor is a higher-pitched noise that occurs with obstruction in or just below the voice box. Determination of whether stridor occurs during inspiration, expiration or both helps to define the level of obstruction.
  • Wheezing is a high-pitched noise that occurs during expiration. Wheezing typically is due to narrowing, spasm or obstruction of the smaller airways in the lungs.

What are Concerning Symptoms of Noisy Breathing?

It can be difficult for a parent or family member to discern the severity of a problem when there is noisy breathing. If you are concerned, you should seek medical evaluation immediately.

Signs that indicate more severe conditions include: irritability, poor feeding, pulling in of the skin at the collar bone, between the ribs, or under the ribs, flaring of the nose, increasing effort to breathe and poor weight gain or weight loss, especially in infants.

Symptoms that should trigger emergency evaluation include: pauses in the breathing, color change of the skin (particularly if the lips, face or hands are turning blue), drooling, appearing lethargic or tired, or any other sudden change from a child’s normal breathing pattern. If any of these or other concerning signs develop, please seek immediate medical attention.

What are Some  Causes of Noisy Breathing?

  • Viral or bacterial infections can cause swelling of the tissues in the airway (such as a cold causing nasal congestion) anywhere from the nose to the lungs. Depending on the type of infection, this could be treated with supportive care, medications or more invasive intervention. Croup is an example of a viral infection that causes swelling and related narrowing of both the larynx and trachea.
  • Fixed narrowing of the airway at birth can result from certain conditions. This can occur at multiple points in the respiratory tract. An example of this includes congenital subglottic stenosis.
  • Abnormal swelling or a growth within the respiratory tract can cause obstruction. Swelling or scarring can cause acquired subglottic stenosis. This also could include a cyst or vascular birthmark (hemangioma) in the airway. A foreign object or food item can be aspirated (sucked into) the airway and can cause obstruction and noisy breathing.
  • Floppy tissues in the respiratory tract can cause noisy breathing due to the collapse of these tissues into the airway. This can partially obstruct airflow. Examples of this include pharyngomalacia, laryngomalacia, tracheomalacia and bronchomalacia.
  • Compression of the airway from an external structure can be due to a crossing blood vessel, the heart or other structures outside of the airway that put pressure on the airway and cause collapse.
  • Spasm of the airways related to underlying medical conditions, like asthma, or due to irritants in the environment.
  • Problems with the vocal cords moving normally. This can occur with Vocal Cord Paralysis or with Paradoxical Vocal Cord Dysfunction (PVCD).
  • Recurrent Respiratory Papillomatosis (RRP) can cause a problem with the voice and also can cause noisy breathing.

How is Noisy Breathing Evaluated?

Evaluation of noisy breathing starts with documenting the patient’s history and performing a physical examination. This information is critical in narrowing down the cause of noisy breathing and in determining how severe the symptoms are. Important aspects of the history include whether it was present at birth, or developed later on, and the course in time over which it developed. Certain characteristics of the noisy breathing help to determine the location of narrowing. These include whether noisy breathing occurs on inspiration, expiration or both. The pitch and loudness of noisy breathing also is an important factor.

Depending on the history and examination findings, a pediatric otolaryngologist may recommend an in-office laryngoscopy/nasopharyngoscopy or an operative laryngoscopy and bronchoscopy. At times, certain x-rays or other tests, like sleep studies and swallowing studies, may be recommended.

What is the Treatment for Noisy Breathing?

Many treatment options are available for noisy breathing and depend on the cause of the symptoms. At times, monitoring and supportive care are recommended. Certain medications may be helpful in treating symptoms or managing related conditions.

For more severe issues, surgery may be recommended. A pediatric otolaryngologist will discuss all possible treatment options and make recommendations for the most appropriate treatment.