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Otorhinolaryngology > Upper airway > Flashcards

Upper airway Flashcards

1
Q

What are the signs/symptoms of upper airway obstruction?

A

stertor or stridor

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2
Q

What is stridor?

A

High pitched noisy breathing due to respiratory obstruction

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3
Q

What is stridor commonly caused by?

A

A respiratory obstruction such as:

croup

allergic reaction (anaphylaxis)

a foreign body

abscess

cancer

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4
Q

What is stertor?

A

Low pitched noise

on inspiration (ABOVE the larynx)

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5
Q

What is a common cause of stertor?

A

Enlarged tonsils

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6
Q

What is a tracheostomy?

A

A hole is made in the trachea and a breathing tube is inserted.

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7
Q

What are the functions regarding breathing of the nose?

A

Humidifying, filtering and warming the air

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8
Q

What are the indications for a tracheostomy?

A

Obstructive reason
-> Bypass an obstruction above the tracheostomy

Surgical reasons:

- > To prevent breathing problems from swelling of the larynx post surgery
- > Post-laryngectomy

Lowered consious level reasons:

- > Aritificial respiration
- > If there is substantial risk of aspiration
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9
Q

What are the two types of tracheostomy and what are their indications?

A

a) end tracheostomy – performed as part of a laryngectomy
b) side tracheostomy – here the larynx is left in place and an airway is put through the skin over the trachea. For shorter term reasons.

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10
Q

What are some early risks of tracheostomy?

A

Pneumothorax

Dysphagia

Surgical emphysema

tracheitis

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11
Q

What are some late risks of tracheostomy?

A

tracheocutaneous fistula on removing the tube

tracheaoesophageal fistula

tracheal stenosis

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12
Q

What causes snoring?

A

Vibration of one or more areas of the upper airway.

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13
Q

What is obstructive sleep apnoea hypopnoea syndrome (OSAHS)?

A

excessive daytime sleepiness

with repeated collapses of the upper airway

usually associated with desaturations

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14
Q

Describe what happens when a pt stops breathing due to sleep apnoea?

A

hypoxia occurs

a central impulse then causes a slight lightening of consciousness

and an increased respiratory effort

to overcome the obstruction.

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15
Q

What is the relationship between sleep apnoea and snoring?

A

Not all people who snore have sleep apnoea

but

all people who have sleep apnoea will snore

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16
Q

What is the diagnostic criteria for sleep apnoea?

A

30 or more episodes of cessation of breathing

each lasting at least 10 seconds

occurring over a 7 hour period of sleep.

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17
Q

How can one differentiate between sleep apnoea and snoring?

A

Snoring is disruptive snoring without any impact on:

sleep pattern or

daytime sleepiness

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18
Q

Are men or women more likely to develop snoring/sleep apnoea? (Why?)

A

Men are 2-5 times more likely.

Oestrogen is thought to be protective as risk increases post menopause

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19
Q

Which age groups are most at risk from snoring/sleep apnoea?

A

The risk constantly increases until 60 y/o

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20
Q

What is the link between obesity and snoring/sleep apnoea?

A

70% risk if BMI >40

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21
Q

What social habits can increase the risk of snoring/sleep apnoea?

A

Smoking + drinking

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22
Q

What are the consequences of sleep apnoea?

A

a) Neurocognitive effect – daytime sleepiness causes

a cognitive deterioration

and can increase the risk of an accident (e.g. RTA)

b) Cardiovascular – can contribute to

systemic hypertension

as well as pulmonary hypertension

and eventually ventricular failure (i.e. cor pulmonale)

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23
Q

How can snoring/sleep apnoea be assessed?

A

Sleep studies

Invasive endoscopies with vibration detector on them

24
Q

When are sleep studies indicated in snoring/sleep apnoea?

A

Pt’s with COPD or resp problems

For truckers/heavy machinary workers

Pt’s being considered for surgery

25
Q

What is the demographic of snoring/sleep apnoea in children?

A

is similar in both sexes and does not increase with age

26
Q

What is the peak age for snoring/sleep apnoea in children? (and why)

A

Between 2 and 5 y/o

it is when the adenoid and tonsils are largest

27
Q

What are the signs of snoring/sleep apnoea in children?

A

It’s paradoxical:

Failure to thrive (rather than obesity)

Overactive (rather than sedated)

28
Q

What are the generic treatments for sleep apnoea?

A

1) Weight loss (very effective)
2) Lifestyle changes - alcohol, smoking, sedatives
3) Continuous positive airway pressure (CPAP)
4) Intra-oral appliances
5) Pharmacological treatments
6) Upper airway surgery (e.g. tracheostomy) /radioablation

29
Q

What is the gold standard treatment for snoring/sleep apnoea and describe how it works?

A

Continuous positive airway pressure (CPAP)

Pt wears a mask that delivers a +ve pressure

thus keeping the airway open after expiration preventing obstruction

(pts do not like it)

30
Q

What are intra-oral appliances and what are the side-effects?

A

devices that open the airway or

fix the mandible in place

side effects such as

drooling

joint discomfort

31
Q

When do episodes of snoring/sleep apnoea occur most in the sleep cycle?

A

REM sleep

32
Q

What are the mechanisms used to treat snoring/sleep apnoea with pharmacological agents?

A

either:

reduce the amount of REM sleep or

to increase respiratory effort.

(both can be effective in selected patients)

33
Q

What are the two types of stridor and what levels do they occur at?

A

inspiratory (level of larynx)

and/or

expiratory (level of bronchi/bronchioles), it is the wheeze of asthma

34
Q

What is the umbrella term that encompasses snoring and sleep apnoea?

A

Obstructive sleep related breathing disorders (SRBDs)

35
Q

What is upper airways resistance syndrome (UARS)?

A

Essentially snoring with increased respiratory effort

36
Q

What is apnoea?

A

stopping of breathing

37
Q

What are the risks of acute epiglottitis?

A

It is potentially life threatening due to airway obstruction

38
Q

What is croup also called?

A

Laryngotracheobronchitis

39
Q

What is croup characterised by?

A

Oedema and vascular engorgement of the airways

40
Q

What are the signs of croup?

A

intially a low-grade URTI

then inspiratory stridor

then cough like bark of dog

41
Q

Who can be affected by acute epiglottitis?

A

adults and children

42
Q

What is the most common causative aetiological agent in acute epiglottitis?

A

Haemophilus influenzae type b (Hib) but less common due to vaccination

43
Q

What is the tell-tale sign that a child has acute epiglottitis?

A

They drool as its too painful to swallow

44
Q

What must you be careful not to do in children with suspected airway obstruction?

A

Do not make them cry by upsetting them as this may further compromise the airway.

45
Q

What age group does epiglottitis commonly occur in in children?

A

3-6 yrs

46
Q

What age group does croup commonly occur in in children?

A

1-8yrs

47
Q

How fast is the onset of acute laryngitis?

A

gradual

48
Q

How fast is the onset of acute epiglottitis?

A

rapid

49
Q

How fast is the onset of croup?

A

gradual (after cold)

50
Q

What is the treatment for acute larngititis?

A

supportive

51
Q

What is the treatment for acute epiglottitis?

A

antibiotics

intubation

52
Q

What is the treatment for croup?

A

nebulised racemic of adrenaline and bronchdilator

systemic steroids

53
Q

In airway obstruction what can help buy time before an expert arrives?

A

Heliox (mixture of Helium and Oxygen)

54
Q

What is treatment of choice for OSAS in children?

A

adenotonsillectomy

55
Q

Other than obstructive sleep apnoea syndrome (OSAS), what is the other type of sleep apnoea?

A

Central sleep apnoea (essentially a loss of central respiratory drive)

Otorhinolaryngology (7 decks)

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