Stridor, Snoring, Stertor And Wheezing: How They Compare

The following are all types of noisy breathing;

Stridor:

A high-pitched sound heard during breathing, typically indicative of upper airway obstruction.
Snoring:

A low-pitched sound produced by vibration of the upper airway tissues during sleep.
Stertor:

A low-pitched snoring sound, often associated with nasal or pharyngeal obstruction.
Wheezing:

A high-pitched whistling sound heard during breathing, typically indicative of lower airway obstruction.

Epidemiology

Snoring:

Common in adults, especially those with obstructive sleep apnea (OSA).

Stertor:

Often seen in children with nasal or pharyngeal obstruction.

Stridor:

Can occur in anyone, but more common in children and individuals with upper airway obstruction.

Wheezing:

Common in individuals with asthma, chronic obstructive pulmonary disease (COPD), or other lower airway conditions.

Pathophysiology

Stertor:

Nasal or pharyngeal obstruction, often due to adenoid or tonsillar hypertrophy. Can occur during both wakefulness and sleep.

Snoring:

Vibration of upper airway tissues, often due to relaxation of muscles or anatomical obstruction. Typically occurs during sleep.

Stridor:

Upper airway obstruction, often due to foreign bodies, tumours, or anatomical abnormalities.

Wheezing:

Lower airway obstruction, often due to bronchospasm, inflammation, or mucus plugging.

Mechanism and Location

Snoring & Stertor:

Typically occur during inspiration, due to upper airway obstruction.

Wheezing:

Typically occurs during expiration, due to lower airway obstruction.

Stridor:

Inspiratory stridor:

Indicates obstruction above the vocal cords.
Expiratory stridor:

Indicates obstruction below the vocal cords.
Biphasic stridor:

Indicates obstruction at or near the vocal cords.

Here’s a breakdown of the location of obstruction for each type of stridor.

Inspiratory Stridor

Typically indicates an extrathoracic obstruction, often above the vocal cords.

Common causes include:

Laryngomalacia
Vocal cord paralysis
Foreign body obstruction
Tumors or cysts in the upper airway.

Expiratory Stridor

Typically indicates an intrathoracic obstruction, often below the vocal cords.

Common causes include:

Tracheomalacia
Bronchial tumors or foreign bodies
Tracheal stenosis:

Biphasic Stridor

Typically indicates an obstruction at or near the glottis (vocal cords), which can be either extrathoracic or intrathoracic.

Common causes include:

Vocal cord lesions or tumors
Bilateral vocal cord paralysis
Glottic stenosis

Summary of Key Differences

Between Snoring and Stridor

Snoring and Stridor are both abnormal sounds produced during breathing, but they have distinct differences.

Snoring

1. Low-pitched sound:

Typically a low-frequency sound.
2. During sleep:

Often occurs during sleep, especially in individuals with obstructive sleep apnea (OSA).
3. Upper airway obstruction:

Caused by partial obstruction of the upper airway, often due to relaxation of muscles or anatomical issues.
4. Common in adults:

More prevalent in adults, especially those with obesity, nasal congestion, or other risk factors.

Stridor

1. High-pitched sound:

Typically a high-frequency sound.
2. During breathing:

Can occur during inspiration, expiration, or both.
3. Upper airway obstruction:

Caused by significant obstruction of the upper airway, often due to anatomical abnormalities, foreign bodies, or other conditions.
4. Can occur at any age:

Affects individuals of all ages, including children and adults.

Key Differences

1. Pitch:

Snoring is typically low-pitched, while stridor is high-pitched.
2. Timing:

Snoring usually occurs during sleep, while stridor can occur at any time.
3. Severity:

Stridor often indicates a more significant obstruction or underlying condition.

Between Snoring and Stertor

Snoring and Stertor are both sounds produced during breathing, but they have distinct differences.

Snoring

1. Low-pitched sound:

Typically a low-frequency sound.
2. Upper airway obstruction:

Caused by partial obstruction of the upper airway, often due to relaxation of muscles or anatomical issues.
3. Often associated with sleep:

Commonly occurs during sleep, especially in individuals with obstructive sleep apnea (OSA).

Stertor

1. Low-pitched snoring sound:

Similar to snoring, but often more nasal or pharyngeal in origin.
2. Nasal or pharyngeal obstruction:

Caused by obstruction in the nose or pharynx, often due to adenoid or tonsillar hypertrophy.
3. Can occur during wakefulness or sleep:

Not limited to sleep, can occur during both wakefulness and sleep.

Key Differences

1. Location of obstruction:

Snoring can involve various upper airway structures, while stertor is more specifically related to nasal or pharyngeal obstruction.
2. Sound characteristics:

While both are low-pitched, stertor is often described as more nasal or guttural.

Understanding these differences can help identify the underlying cause of the sound and guide appropriate management. Also, for accurate diagnosis and treatment.

It’s essential to determine the underlying cause and location of the obstruction to guide appropriate management and treatment.

Investigations

1. Stridor:

Laryngoscopy, bronchoscopy, or imaging studies (e.g., X-rays, CT scans).
2. Snoring and stertor:

Sleep studies (e.g., polysomnography), nasal endoscopy.
3. Wheezing:

Spirometry, peak flow meters, or imaging studies (e.g., X-rays, CT scans)

Complications

1. Stridor:

Respiratory distress, airway compromise.
2. Snoring and stertor:

Sleep disturbances, daytime fatigue.
3. Wheezing:

Respiratory distress, exacerbation of underlying conditions (e.g., asthma).

Management

1. Stridor:

Depends on the underlying cause, may require airway management or surgical intervention.
2. Snoring and stertor:

Lifestyle modifications (e.g., weight loss, sleep position changes), CPAP therapy, or surgical intervention.
3. Wheezing:

Depends on the underlying cause, may require bronchodilators, corticosteroids, or other medications.

In conclusion,

Stridor, snoring, stertor, and wheezing are distinct respiratory sounds with different underlying causes and management strategies. Accurate diagnosis and treatment are essential to prevent complications and improve outcomes.

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