Upper Airway Problems in Daily Practice

Rangga Rayendra Saleh

Department of Otorhinolaryngology - Head and Neck Surgery

Cipto Mangunkusumo Hospital Faculty of Medicine Universitas Indonesia

Overview

• Introduction

• Anatomy and physiology

• Most Common Cases Diagnosis and Management

• Conclusion

Upper Airway

• Upper airway consists of:

• Nose

• Nasopharynx

• Oropharynx

• Larynx

• Continuous passage from nostrils to lungs

• Interaction with lower airway: United

Airway concept

Nose

• External : bony & cartilage part• Internal: divided by nasal septum• Lateral wall:

• Nasal turbinates • Ostium of paranasal sinuses

• Mucosa: ciliated pseudostratified glandular columnar epithelium• Mucociliary transport

Mucociliary transport of the nose and paranasal sinuses

Oropharynx

• Connects nasopharynx and

hypopharyx/larynx

• Bounded anteriorly by the

papillae of the tongue and

anterior tonsillar pillars

• Consists of: tongue base,

palatine tonsils, soft palate, and

oropharyngeal mucosa and

constrictor muscles

Larynx

• Located in the anterior neck

• Functions:

• Phonation

• Cough reflex

• Protection of the lower

respiratory tract

• Primarily cartilaginous

Most common cases

• Acute/Chronic Rhinosinusitis

• Acute/Chronic Tonsilopharyngitis

Acute Rhinosinusitis

Acute Rhinosinusitis

• Rhinitis and sinusitis usually coexist and concurrent

• Affecting 6 - 15% of the population

• Acute rhinosinusitis in adults:

• Sudden onset of two or more symptoms, one of which should be either nasal

blockage/obstruction/congestion or nasal discharge (anterior/posterior nasal drip:

• + facial pain/pressure

• + reduction or loss of smell

• For < 12 weeks, with symptom free intervals if it is recurrent

Acute Rhinosinusitis

• Acute rhinosinusitis in children:

• Sudden onset of two or more of the symptoms:

• Nasal blockage/obstruction/congestion

• Or discoloured nasal discharge

• Or cough (daytime or night time)

• For < 12 weeks, with symptoms free intervals if it is recurrent

Classification of ARS in

adult and children

• Common cold/acute viral

rhinosinusitis: <10 days

• Acute post viral rhinosinusitis:

increase of symptoms after 5 days or

persistent >10 days and < 12 weeks

Classification (2)

• Acute bacterial rhinosinusitis:

• Presence of at least 3 sign/symptoms of:

• Discoloured discharge (with unilateral predominance)

• Severe local pain (with unilateral predominance

• Fever (>38)

• Elevated ESR/CRP

• Double sickening

• Etiology: Streptococcus pneumoniae, Haemophilus influenza, Moraxella catarrhalis, Staphylococcus

aureus

Nasal saline irrigation

Medication

• Decongestants:

• Oral decongestants: usually combined with antihitamine

• Topical decongestants: alpha blocker

• Topical steroids

• Antibiotics (for selected cases)

• Amoxicillin clavulanate (3 x 625 mg 7 - 10 days)

• Azithromycin (1x500 mg 3 days)

• Levofloxacin (1x500 mg 10 days)

Chronic Rhinosinusitis

(with or without nasal polpyps)

Chronic Rhinosinusitis

• Definition:

• Inflammation of the nose and paranasal sinuses, characterised by two or more symptoms, one of which should be either nasal

blockage or nasal discharge

• + facial pain/pressure

• + reduction or loss of smell

• For > 12 weeks

• Either endoscopic signs of

• Nasal polyps and/or

• Mucopurulent discharge from middle meatus

• Mucosa obstruction in middle meatus

• And/or CT changes : ostiomeatal complex

Tonsilitis & pharyngitis

Tonsilitis and Pharyngitis

• Inflammation of the tonsils and posterior

pharyngeal wall

• Might coexist or happens individually

• Most common cause: viral infection

• Signs and symptoms:

• Odinophagia

• Cough

• Headache

• Detritus

• Swollen tonsils

Viral vs Bacterial Infection

Centor Score

Management

• Viral infection:

• Antibiotics are not indicated

• Symptomatic treatment

• Antiseptic lozenges and antibacterial mouthwash are not recommended

• Bacterial infection:

• Delay treatment until culture confirms diagnosis

• Empiric treatment for several conditions

• Group A streptococcal infection: 10 days antibiotics

Surgery for Chronic Tonsillitis

Conclusion

• Upper airway is a continuous passage that correlate with the lower airway

(United airway concept)

• History taking and physical examination: important to determine viral or

bacteria infection

• Antibiotics should be reserved only for confirmed bacterial infection

• Irrational use of antibiotics will increase microorganism resistance and cost

Thank You