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Stridor is a high frequency noise originating from the upper airway (trachea and larynx).
Stertor is a lower frequency noise that originates from the airway above the larynx (oropharynx and nasopharynx).
The management of a patient with upper airway obstruction is dependent on: the severity of airway obstruction, the history, which will give some indication as to the site and cause of the obstruction, and whether the patient is a child or adult. The trachea in a child is much smaller in diameter than an adult and any reduction in the airway results in a significant increase in resistance and therefore respiratory effort.

CHILD
Key points
1. do not unsettle the child
2. call for help – the most senior anaesthetist available
3. beware the child who seems improved because their breathing has quitened – this may indicate an exhausted child who is giving up.
Priority – secure the airway
In sever upper airway obstruction the airway needs to be secured. The best way to do this is by endotracheal intubation. Ideally this should be performed in the operating theatre to provide the facility of endoscopic examination of the airway to determine the diagnosis and to perform a Broncnoscopy in case of failed intubation. If the child is stable, nebulised adrenaline (1ml of 1 in 1000) should be given to reduce any oedema in the airway. This can be repeated as is necessary.
DO NOT attempt to gain intravenous access as this may precipitate laryngospasm. If however access is already available, then intravenous steroids (dexamethasone: 200-500 micrograms/kg daily) may be given. Only when a child is stable, should investigations such and X-rays be performed. A lateral soft tissue view of the neck can be helpful in determining the diagnosis. The child should be kept under close observation to ensure there is no deterioration.

ADULT
The principles of airway management are essentially the same as in a child but there is more time available due to the size of the airway.
Diagnosis is essential in determining management and nasendoscopy should be performed to reach a diagnosis. Again nebulised adrenaline should be used to reduce any oedema and can be given as is necessary (dose: 1ml of 1 in 1000). Intravenous steroids should also be given, again to reduce any airway oedema (dexamethasone 8mg tds). These measures are usually sufficient to buy time before deciding on definitive management.