Inter-observer reliability of localization of recorded stridor sounds in children

The clinical observation of stridor in children shows poor levels of localization. Even though the two most common diagnoses, laryngomalacia and tracheomalacia are localized more correctly, the general performance is not significantly higher than random. No evidence was found in this study for differences in results by the observer's level of experience. We would recommend that an observational policy is only adequate when clear clinical signs are present that indicate laryngomalacia as first differential diagnosis. In other cases rigid and flexible endoscopy is indicated to locate the site and nature of obstruction.