OR WAIT 15 SECS
Nonorganic (psychogenic or malingering) stridor is a rare condition that mimics partial upper airway obstruction of organic origin. The presentation causes appropriate concern in parents and physician alike. Often, the physician becomes suspicious of the psychogenic nature of the problem based on subtle cues, such as the patient's affect or ability to speak normally.
A two-step process can confirm the diagnosis once you have established that the patient has normal vital signs, including arterial oxygen saturation, and is awake and alert.
Have the patient hold his breath for as long as possible (be sure to provide encouragement). Thirty to 45 seconds is usually long enough. When the patient stops holding his breath, he will take multiple large, stridor-free, involuntary breaths. Most malingerers give up at this point. Those with psychogenic stridor may regress to stridor, but you can safely direct your energies to psychological therapy instead of airway management.
Dante Pappano, MD Kevin O'Gara, MD Rochester, N.Y.