Differential Diagnosis for Rough Noise on Inspiration

• Single most likely diagnosis
  • Stridor: This is the most likely diagnosis for a rough noise on inspiration, as stridor is a high-pitched sound that occurs due to an obstruction in the upper airway, typically at the level of the trachea or larynx. It is often associated with conditions such as croup, epiglottitis, or foreign body aspiration.
• Other Likely diagnoses
  • Wheezing: Although wheezing is more commonly associated with expiration, it can also occur during inspiration, especially in the context of severe asthma or chronic obstructive pulmonary disease (COPD). The sound is typically a high-pitched whine.
  • Rhonchi: These are low-pitched sounds that can occur during both inspiration and expiration, often associated with secretions or obstruction in the larger airways, as seen in bronchitis or pneumonia.
• Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
  • Epiglottitis: Although less common, epiglottitis is a life-threatening condition that can cause stridor due to inflammation of the epiglottis, potentially leading to airway obstruction. It requires immediate medical attention.
  • Foreign Body Aspiration: This is another critical condition that can cause sudden onset of stridor or other abnormal inspiratory sounds, especially in children. Prompt recognition and removal of the foreign body are crucial.
• Rare diagnoses
  • Laryngomalacia: A condition where the soft tissues of the larynx are floppy, leading to partial airway obstruction during inspiration, typically seen in infants.
  • Vocal Cord Paralysis: Unilateral or bilateral paralysis of the vocal cords can lead to abnormal sounds during inspiration due to impaired vocal cord function, which can be due to neurological conditions or trauma.
  • Tracheomalacia: A rare condition characterized by the softening of the tracheal cartilages, leading to tracheal collapse during inspiration, which can cause stridor or other abnormal sounds.