Upper Airway Diseases Flashcards
main fn of sinuses
filter, humidify, warm inspired air
3 cardinal sx of rhinosinusitis
purulent rhinorrhea, facial pain/pressure, nasal obstruction
differ acute, subacute, and chronic rhinosinusities
by timeline: acute up to 4 weeks w/ total resolution
subacute- more than 4, but less than 12 weeks w/ resolution
chronic- 12 weeks or more
Acute rhinosinusitis causes
mostly viral (rhinovirus, coronavirus, influenza)
more rarely bacterial- dx after 10 days of sx or improvement and then worsening
-strep pneumo and H flu and moraxella catarrhalis most common
Tx of ARS
Sx management usually
persistent/severe Sx tx w/ antibiotics
intranasal steroid
saline irrigations
2 mechanism of ARS complication
loss of anatomic border or hematologic spread
fundamental diff of CRS and ARS
12 weeks or more and considered more of an inflammatory disorder than infectious
Dx of CRS
Sx Dx unreliable, CT is gold standard
most common predisposing factor to CRS in adults
allergies, usually IgE mediated allergic rhinitis
genetic predisposition to CRS
primary ciliar dyskinesia and cystic fibrosis
associated w/ higher rates of surgery
describe primary ciliary dyskinesia
auto recessive, disorganized microtubules and absent dynein
chronic bronchitis, bronchiectasis, pneumonia, 50% have situs inversus,
3 strategies for CRS Tx
mechanical: saline irrigations
anti inflammatory: antihistamine, oral and topical steroids
antimicrobial: based on culture results, usually S aureus, anaerobes, G-, pseudo aeruginosa
2 systemic conditions that involve sinuses
granulomatosis w/ polyangitis (Wegeners)- idiopathic vasculitis in airways and kidneys
sarcoidosis
diff b/w allergic and invasive fungal sinusitis
allergic: CRS subset, Tx w/ surgery and post op medical
invasive: ENT emergency, usually immunocompromised, rapid necrosis, usually rhizopus, mucor, aspergillus, Tx w. debridement and IV antifungals
which Sx should raise concern for sinonasal tumor?
frequent, unexplained nosebleeds, discharge, sinus pain, unusual Sx like visual changes, tearing, neck nodes, hypoesthesia (numbness)
pharyngitis etiologies
mostly viral
less common bacterial: usually group A beta hemolytic strep pyogenes
physical exam for bacterial pharyngitis
swollen tonsils w/ exudate, maybe petechiae, bad breath
Tx for bacterial pharyngitis
pts are contagious, penicillin first line and can prevent complications like glomerulonephritis and ARF
Tx for infectious mono
rest, avoid contact sports
antivirals dont help, antibiotics for secondary bacterial infections
NO ampicillin or amoxicillin
steroids for upper airway obstruction
associations w/ peritonsillar abscess
trismus (lockjaw), muffled (hot potato) voice, drooling
key Sx of retropharyngeal abscess
neck stiffness, odynophagia (painful swallowing)
complications of retropharyngeal abscess
mediastinitis, airway obstruction, IJV thrombosis, sepsis
where is danger space
b/w alar fascia and prevertebral fascia
Ludwigs angina
inflammation and cellulitis of submandibular space
life threatening, requires tracheotemy typically
abduction vs adduction in the larynx
abducted for breathing, adducted for sound production and swallowing
when is dysphonia likely other than viral laryngitis
more than 2 weeks and other Sx like otalgia, dysphagia, difficulty breathing
causes of hoarseness
neuro injury (think recurrent laryngeal nerve) or alterations of vocal cord lining (GERD and dehydration can do this)
most common cause of vocal fold lesions
phonotrauma
common benign vocal fold lesions
hemorrhage, polyp, cyst, reinke’s edema, granuloma
what is the most common benign neoplasm in pediatric larynx? etiology?
recurrent respiratory papillomatosis, from HPV 6 and 11
Tx of vocal fold lesions
combo of med Tx, speech therapy, surgery
most common cause of unilateral vocal fold paralysis
iatrogenic injury
risk factors for laryngeal carcinoma, type of cancer
smoking is main factor, EtOH is synergistic
usually sqamous cell carcinoma
most common location for laryngeal carcinoma
glottic- in vocal folds
Sx of laryngeal carcinoma
most common is hoarseness
dysphagia, hemoptysis, throat/ear pain, neck mass*
diff b/w early and advanced Tx for laryngeal carcinoma
single modality early and combined modality w/ advanced (surgery followed by radiation)
consequences of laryngectomy
cannot speak- require assistance w/ electrolarynx, esophageal speech (burping), tracheoesophageal speech
need to be intubated through the tracheal incision, cannot go through the nose/mouth
most common cause of upper airway obstruction in kids
adenotonsillar hypertrophy
stridor
high pitch breathing from turbulent airflow, more on inspiration but can be expiratory or biphasic
stertor
noise from nose, nasopharynx, oropharynx
low pitched, snoring
wheezing
high pitched, indicates lower airway disease, more commonly at end expiration
signs of epiglottitis
thumb sign on saggital xray
airway emergency
typical bacteria of epiglottitis
h flu type b, strep
tx for epiglottitis
secure airway, flexible intubation, tracheotemy
avoid agitation
characteristics of croup
epi, sx, risk, xray
common, viral, pediatric
barking cough, stridor, hoarse, difficulty breathing
swelling from inflammation leads to narrow airway
steeple sign in frontal xray
laryngomalacia
congenital presents less than 2 mos old, floppy cartilage leads to collapse and inspiratory stridor
worse w/ feeding or supine
laryngotracheal stenosis
narrowing of larynx or trachea
SOB, inspiratory stridor, no help w/ inhaler
can be progressive, often misdiagnosed as asthma or bronchitis
risk of prolonged intubation
airway stenosis
