Version June 2024
| Disease | Clinical features | Laboratory | Pulmonary function testing | Chest imaging | Other testing that may be useful in selected patients |
| Anaphylaxis with laryngeal edema | Abrupt onset of wheezing with urticaria, angioedema, and hypotension | Serum or plasma tryptase Plasma histamine Urinary histamine or histamine metabolites Immunoassay to identify culprit | Generally not needed unless patient fails to respond to therapy | Laryngoscopy to identify swelling of vocal folds (cords) and surrounding tissue | |
| Cricoarytenoid arthritis | Hoarseness and stridor in a patient with rheumatoid arthritis; onset may be acute | Rheumatoid factor; anti-cyclic citrullinated peptide antibodies | Flow volume loop likely to show variable extrathoracic airflow limitation, but patient may not be able to perform testing | Laryngoscopy showing fixation of vocal folds in a midline position | |
| Vocal fold edema, hematoma, or paralysis | Dyspnea and wheeze or stridor History of neck or thyroid surgery or intubation | Flow volume loop likely to show variable extrathoracic airflow limitation | Laryngoscopy | ||
| Paradoxical vocal fold motion | Patients may present with significant respiratory distress and dramatic inspiratory stridor. They may complain of throat tightness, choking sensation, dysphonia, or cough. They may also describe worsening of stridor or wheeze with vigorous exercise. | Flow volume loops show variable inspiratory slowing, but may be normal between episodes when patient is asymptomatic | Laryngoscopy at time of symptoms shows paradoxical inspiratory and/or early expiratory adduction of vocal folds; glottic aperture may be obliterated except for a posterior diamond-shaped passage | ||
| Laryngeal stenosis | History of neck trauma, irradiation, or endotracheal intubation | FV loop may show fixed or variable inspiratory slowing | Neck radiograph | Laryngoscopy | |
| Laryngocele | Usually asymptomatic but may present with hoarseness, dyspnea, dysphagia, inspiratory stridor | CT imaging | Laryngoscopy showing smooth swelling near false vocal fold and aryepiglottic fold | ||
| Epiglottitis (supraglottitis) | Acute onset of severe sore throat out of proportion to pharyngitis; dysphagia Tenderness of neck in area of hyoid bone | Complete blood count and differential Blood cultures Epiglottal cultures ONLY after airway is secure | Lateral neck radiograph (if obtained) shows enlarged epiglottis protruding from anterior wall of the hypopharynx, "thumb sign" Ultrasound shows: "alphabet P sign", formed by an acoustic shadow of the swollen epiglottis and hyoid bone | Depending on severity of respiratory compromise, flexible laryngoscopy | |
| Goiter | Slowly enlarging thyroid mass | TSH | Flow volume loop may show airflow limitation depending on location/severity of compression | Neck/chest radiograph may show extrinsic airway compression, but CT usually needed to assess degree of narrowing. Thyroid tissue has characteristic appearance on CT. | Laryngoscopy or bronchoscopy may be needed to assess airway narrowing |
| Postnasal drip syndrome | Nasal congestion and rhinorrhea, may have seasonal symptoms | FV loop may show extrathoracic variable upper airway obstruction and normal bronchoprovocation | May need sinus CT to evaluate cause of postnasal drip if skin testing negative | Trial of therapy (eg, older antihistamine if not histamine mediated, intranasal steroids) Allergy skin testing | |
| Relapsing polychondritis causing larynx, glottis, subglottic inflammation and narrowing | Wheeze can be expiratory or inspiratory depending on location of cartilaginous damage Usually has associated involvement of cartilage of ears, nose, ribs, eyes | No available diagnostic tests Need to exclude tuberculosis, syphilis Autoantibodies may be positive (eg, ANA, ANCA, RF) | Flow volume loop shows variable intrathoracic or extrathoracic airflow limitation | Chest x-ray may show tracheal narrowing Lateral neck radiograph may show calcification of tracheal or laryngeal cartilage MRI may differentiate inflammation from fibrosis | Patients with relapsing polychondritis should also be evaluated for involvement of cardiac valve cartilage with Doppler echocardiography |
| Retropharyngeal abscess | Subacute (hours to days) onset of stiff neck, sore throat, fever, history of penetrating trauma to posterior pharynx | Complete blood count and differential blood cultures Culture of abscess fluid, if drained | Lateral neck radiograph or CT imaging may demonstrate cervical lordosis with retropharyngeal space swelling and gas collections. Imaging is used to determine whether a loculated abscess has developed that can be surgically drained. | Direct visualization | |
| Tonsillar hypertrophy | Typically presents in children and adolescents rather than adults | Flow volume loop may show inspiratory slowing | Enlarged tonsils visible on oropharyngeal exam | ||
| Tumor of pharynx, larynx, upper trachea | Hoarseness, dyspnea, stridor | Flow volume loop may show inspiratory slowing | CT scan of neck | Laryngoscopy |
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