Stridor, Epiglottitis & Deep Neck Infection
Recognise upper-airway danger and coordinate urgent care without provoking deterioration.
Quick revision ↓ Medical Dictionary
01Recognise obstruction
Stridor is a high-pitched upper-airway sound and differs from lower-airway wheeze. Assess work of breathing, voice, posture, secretions, colour and consciousness. A patient who becomes quieter while tiring may be deteriorating rather than improving. Call the emergency airway team early and allow a conscious patient to remain in the position that best supports breathing.
02Avoid harmful delay
Airway assessment and resuscitation take priority over routine imaging, blood tests or a complete throat examination. Minimise distress, particularly in children. Do not force a patient with suspected significant obstruction to lie flat or repeatedly manipulate the throat. Definitive airway procedures require the appropriately trained team and a prepared environment.
03Epiglottitis
Rapid severe throat pain, drooling, difficulty swallowing and respiratory distress can indicate supraglottic inflammation. The visible mouth may not explain the severity. Epiglottitis can occur in adults as well as children and is an emergency. Avoid attempting to demonstrate the epiglottis in a distressed patient outside a controlled expert setting.
04Deep neck infection
Neck swelling, trismus, fever, swallowing difficulty or a raised floor of mouth may indicate a deep-space infection, sometimes from a dental source. Airway compromise and sepsis are major risks. Arrange urgent hospital assessment with ENT, anaesthetic and other relevant teams. Antibiotics and source control are selected after urgent stabilisation and evaluation.
05Croup and alternatives
A barking cough and hoarseness in a child can suggest croup, but stridor at rest, exhaustion, cyanosis or poor responsiveness signals more severe disease. Treatment follows the paediatric acute pathway and may require observation after therapy. An atypical course or sudden onset should prompt consideration of foreign body, bacterial disease or another cause rather than automatic croup labelling.
High-Yield Revision
- A tiring patient may become quieter despite worsening obstruction.
- Minimise distress and summon airway expertise early.
- Severe throat symptoms can exceed visible mouth findings.
Common Pitfalls
- Sending an unstable airway to routine imaging first.
- Forcing throat examination in suspected epiglottitis.
References & Further Reading
Read the relevant guideline sections alongside these original clinical teaching cases. Local pathways, available services and individual patient factors determine care.
Reference review: 28 September 2026. Consult current local protocols for prescribing, procedures and escalation.