Assessment of airway stenosis in patients begins with a comprehensive history and physical examination. Tracheal stenosis can present very insidiously or as a catastrophic near death episode requiring cardiopulmonary resuscitation. Dyspnea on exertion appears when about 50% of the airway is narrowed. Dyspnea at rest occurs when 75% of the airway is stenosed. Children with congenital tracheal stenosis present with biphasic stridor, tachypnea, retractions, nasal flaring, apnea, cyanosis, wheezing, noisy breathing, recurrent upper respiratory “cold symptoms,“ persistent croup, and pneumonia. Many patients are misdiagnosed with asthma and recurrent bronchitis. A high index of suspicion is warranted with the onset of respiratory symptoms following intubation, regardless of the duration of intubation. Patients may also present with hoarseness of voice due to vocal fold affection or concomitant laryngeal trauma. Aspiration and spill over may occur due to vocal fold immobility, arytenoid fixation, loss of laryngeal sensation or trachea-esophageal fistula. Various diagnostic techniques must be used to gather this basic information. These include radiology, endoscopy, pulmonary function tests may be indicated as well as investigations to detect gastro-esophageal reflux. Radiological assessment is a central element in the diagnostic workup of these patients. The choice of the proper technique is imperative. The radiological parameters should be very rigorous and precise in order to be valuable. Endoscopy gives a direct real time view of the upper airway, larynx and trachea. It is essential to properly evaluate the air passages both above and, if possible, below the area of stenosis. This necessitates both laryngoscopy, and bronchoscopy. In special circumstances, esophagoscopy may be needed in cases of tracheal stenosis due to malignancy involving the esophagus, if there is trachea-esophageal fistula, or if an esophageal pathology is suspected.