Noisy Breathing (Stertor, Stridor or Wheezing)

What is noisy breathing?

Noisy breathing is common, especially in children, and can be a sign of many different conditions, some of which are very benign and some of which require urgent treatment. 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 create collapse of surrounding tissues, or can be a single fixed point of narrowing.

One type of noisy breathing is Stertor. This term implies a noise created in the nose or the back of the throat. It is typically low-pitched and most closely sounds like nasal congestion you might experience with a cold, or like the sound made with snoring. Stridor is a higher-pitched noisy 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 some causes of noisy breathing?

  • Infection- 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- certain conditions can cause a child to be born with a narrowed airway. 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 could also 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. This is because of collapse of these tissues into the airway. This can partially obstruct airflow and cause collapse of surrounding tissues. Examples of this include pharyngomalacia, laryngomalacia, tracheomalacia, and bronchomalacia.
  • Compression of the airway from an external structure. This 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 can cause a problem with the voice and can also cause noisy breathing.

How is noisy breathing evaluated?

Evaluation of noisy breathing starts with obtaining a 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 has developed later on, and the time course over which it has developed. Certain characteristics of the noisy breathing help us to determine the location of narrowing. These include whether noisy breathing occurs on inspiration, expiration, or both. The pitch and loudness of noisy breathing is also an important factor.

Depending on the history and examination findings, your 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. Your Pediatric Otolaryngologist will discuss all possible treatment options with you and make recommendations for the most appropriate treatment.

What are concerning symptoms that I should look for in my child with 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, we urge you to seek medical evaluation immediately.

In particular, 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 emergent 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.