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Upper Airway Obstruction Rory Attwood Rory Attwood MBChB,FRCS MBChB,FRCS Division of Division of Otorhinolaryngology Otorhinolaryngology Faculty of Health Sciences Faculty of Health Sciences Tygerberg Tygerberg Campus, University of Stellenbosch Campus, University of Stellenbosch

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Upper Airway Obstruction

Rory Attwood Rory Attwood MBChB,FRCSMBChB,FRCS

Division of Division of OtorhinolaryngologyOtorhinolaryngologyFaculty of Health SciencesFaculty of Health Sciences

TygerbergTygerberg Campus, University of StellenboschCampus, University of Stellenbosch

Page 2: Upper Airway Obstruction - Stellenbosch Universityrespiratory function – i.e. noisy breathing resulting from an upper airway obstruction • Merit investigation in every case Introduction

Stridor/Stertor

• Auditory manifestations of disordered respiratory function

– i.e. noisy breathing resulting from anupper airway obstruction

• Merit investigation in every case

Page 3: Upper Airway Obstruction - Stellenbosch Universityrespiratory function – i.e. noisy breathing resulting from an upper airway obstruction • Merit investigation in every case Introduction

Introduction

• Stertor– Caused by obstruction of airway above the

larynx– Vibration in tissues of nasopharynx,

oropharynx or soft palate• Stridor

– Due to airflow changes in the larynx, tracheaor bronchi

Page 4: Upper Airway Obstruction - Stellenbosch Universityrespiratory function – i.e. noisy breathing resulting from an upper airway obstruction • Merit investigation in every case Introduction

Introduction

• Stertor– Caused by obstruction of airway above the

larynx– Vibration in tissues of nasopharynx,

oropharynx or soft palate• Stridor

– Due to airflow changes in the larynx, tracheaor bronchi

Page 5: Upper Airway Obstruction - Stellenbosch Universityrespiratory function – i.e. noisy breathing resulting from an upper airway obstruction • Merit investigation in every case Introduction

Associated signs and symptoms

• Dyspnoea (shortness of breath)

– Severity of one reflects severity of the other

– Beware of signs in neonate and small infant

Page 6: Upper Airway Obstruction - Stellenbosch Universityrespiratory function – i.e. noisy breathing resulting from an upper airway obstruction • Merit investigation in every case Introduction

Associated signs and symptoms (continued)

• Swallowing and breathing

– Share common pathway : oropharynx

– Disorders of the one may interfere with the other

– Stridor/Stertor often increase during feeding

– Infants often noted to be poor or slow feeders

Page 7: Upper Airway Obstruction - Stellenbosch Universityrespiratory function – i.e. noisy breathing resulting from an upper airway obstruction • Merit investigation in every case Introduction

General features: Stridor

• Always a symptom or a sign,never a diagnosis or a disease

• History and physical examination will indicate problem areas

• Endoscopy will confirm final diagnosis

Page 8: Upper Airway Obstruction - Stellenbosch Universityrespiratory function – i.e. noisy breathing resulting from an upper airway obstruction • Merit investigation in every case Introduction

History and physical examination

• Clear “history” of onset, progression and details of exacerbating or relieving features

• FULL examination of:

mouth & nose - oropharynx - larynx - trachea

Page 9: Upper Airway Obstruction - Stellenbosch Universityrespiratory function – i.e. noisy breathing resulting from an upper airway obstruction • Merit investigation in every case Introduction

History and physical examination

• Clear “history” of onset, progression and details of exacerbating or relieving features

• FULL examination of:

mouth & nose - oropharynx - larynx – trachea

. . . will reveal, in most cases, the diagnosis

Page 10: Upper Airway Obstruction - Stellenbosch Universityrespiratory function – i.e. noisy breathing resulting from an upper airway obstruction • Merit investigation in every case Introduction

Examination• Endoscopy - Gold standard

• Evaluate nasal passages, nasopharynx,oropharynx, larynx and trachea

• General anaesthetic if required

• Decide on treatment

Page 11: Upper Airway Obstruction - Stellenbosch Universityrespiratory function – i.e. noisy breathing resulting from an upper airway obstruction • Merit investigation in every case Introduction

Examination

Page 12: Upper Airway Obstruction - Stellenbosch Universityrespiratory function – i.e. noisy breathing resulting from an upper airway obstruction • Merit investigation in every case Introduction

Causes and classification

• Adult

• Children

• Neonatal

Page 13: Upper Airway Obstruction - Stellenbosch Universityrespiratory function – i.e. noisy breathing resulting from an upper airway obstruction • Merit investigation in every case Introduction

Causes: Adult• Malignancy

– Nasopharynx, oropharynx, larynx

• Laryngeal trauma– post intubation

• Acute laryngitis

• Supraglottitis / epiglottitis

Page 14: Upper Airway Obstruction - Stellenbosch Universityrespiratory function – i.e. noisy breathing resulting from an upper airway obstruction • Merit investigation in every case Introduction

Causes: Children

• Laryngotracheobronchitis (Croup)• Epiglottitis• Foreign body• Trauma

– post intubation• Retropharyngeal abscess• Laryngeal papillomata

Page 15: Upper Airway Obstruction - Stellenbosch Universityrespiratory function – i.e. noisy breathing resulting from an upper airway obstruction • Merit investigation in every case Introduction

Causes: Children

• Laryngotracheobronchitis (Croup)• Epiglottitis• Foreign body• Trauma

– post intubation• Retropharyngeal abscess• Laryngeal papillomata

Page 16: Upper Airway Obstruction - Stellenbosch Universityrespiratory function – i.e. noisy breathing resulting from an upper airway obstruction • Merit investigation in every case Introduction

Causes: Children (continued)

Page 17: Upper Airway Obstruction - Stellenbosch Universityrespiratory function – i.e. noisy breathing resulting from an upper airway obstruction • Merit investigation in every case Introduction

Causes: Children

• Laryngotracheobronchitis (Croup)• Epiglottitis• Foreign body• Trauma

– post intubation• Retropharyngeal abscess• Laryngeal papillomata

Page 18: Upper Airway Obstruction - Stellenbosch Universityrespiratory function – i.e. noisy breathing resulting from an upper airway obstruction • Merit investigation in every case Introduction

Causes: Children (continued)

Page 19: Upper Airway Obstruction - Stellenbosch Universityrespiratory function – i.e. noisy breathing resulting from an upper airway obstruction • Merit investigation in every case Introduction

Causes: Neonatal

• Laryngomalacia• Congenital tumors, cysts• Webs• Subglottic stenosis• Vocal cord paralysis

Page 20: Upper Airway Obstruction - Stellenbosch Universityrespiratory function – i.e. noisy breathing resulting from an upper airway obstruction • Merit investigation in every case Introduction

Summary

• Stridor is abnormal and should be investigated

• Laryngeal evaluation has to be performed in all patients with stridor

• Snoring for longer than 6 months in a child is abnormal

Page 21: Upper Airway Obstruction - Stellenbosch Universityrespiratory function – i.e. noisy breathing resulting from an upper airway obstruction • Merit investigation in every case Introduction

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