Can steam inhalation help with mild stridor?

Steam Inhalation for Mild Stridor

Steam inhalation is not recommended as a treatment for mild stridor as there is no evidence supporting its effectiveness, and proper medical evaluation and treatment based on the underlying cause should be pursued instead.

Understanding Stridor

Stridor is a high-pitched respiratory sound caused by turbulent airflow through narrowed upper airways. It is a sign that requires identification of the underlying cause, not a diagnosis itself 1, 2.

• Inspiratory stridor typically indicates obstruction above the glottis (supraglottic or glottic) 3
• Expiratory stridor suggests obstruction in the lower trachea 3
• Biphasic stridor points to a glottic or subglottic lesion 3

Causes of Stridor

The etiology of stridor varies based on age and acuity:

• In infants, laryngomalacia is the most common cause of chronic stridor 4, 5
• In children, croup is the most common cause of acute stridor 3
• Other causes include foreign body aspiration, vocal cord dysfunction, subglottic stenosis, and airway masses 2

Evidence-Based Management Approaches

For Post-Extubation Stridor

• Inhaled epinephrine (not steam) is recommended for treating post-extubation stridor in conscious patients 6
• There is no recommendation for the routine use of methylprednisolone to prevent post-extubation stridor 6

For Croup-Related Stridor

• Nebulized adrenaline (0.5 ml/kg of 1:1000 solution) may be used to avoid intubation or stabilize children prior to transfer to intensive care 6
• Nebulized steroids (e.g., 500 μg budesonide) may reduce symptoms in croup in the first two hours 6
• Adrenaline should not be used in children who are shortly to be discharged or on an outpatient basis 6

Why Steam Is Not Recommended

None of the clinical guidelines or research evidence provided supports the use of steam inhalation for stridor. The guidelines specifically recommend:

• Pharmacological interventions such as inhaled epinephrine for post-extubation stridor 6
• Nebulized medications for croup-related stridor 6
• Proper identification of the underlying cause and appropriate medical or surgical intervention 4, 5

Appropriate Management Approach

1. Assess severity of respiratory compromise to determine need for immediate intervention 1
2. For mild stridor without respiratory distress, referral to an ENT specialist for proper evaluation may be necessary 1
3. For severe stridor with respiratory distress, immediate airway management is required 3
4. Treatment should be directed at the underlying cause rather than symptomatic management with unproven interventions like steam 3

Important Considerations

• Stridor requires proper diagnosis of the underlying cause through history, physical examination, and often flexible airway endoscopy 2
• In infants with laryngomalacia, there is a strong association with gastroesophageal reflux disease, and medical treatment with antireflux medications may be indicated 5
• Severe cases of laryngomalacia may require surgical intervention (supraglottoplasty) 5

The evidence does not support steam inhalation as an effective treatment for mild stridor, and proper medical evaluation should be pursued to identify and address the underlying cause.