URTI and Upper Respiratory Problems Flashcards
Common respiratory tract infections?
- Rhinosinusitis
- Acute pharyngitis
- AOM
- Retropharyngeal and Lateral pharyngeal (parapharyngeal) abscesses
- Tonsilitis and adenoiditis
- Acute inflammatory Upper airway obstruction
Note: Children <2yr in child-care centers have more URTI and LRTI than do age-matched children not in child care.
Causes of rhinosinusitis?
- Rhinoviruses
- coronaviruses
- HMPV
Causes of acute pharyngitis?
- viruses
- GABHS
- 30% of URTI
Causes of AOM?
- S. pneumoniae
- nontypeable Haemophilus influenzae
- Moraxella catarrhalis
Causes of acute inflammatory upper airway obstruction?
- Croup
- epiglottitis
- laryngitis
- Bacterial tracheitis
What is otitis media?
Inflammation of the middle ear
- One of the most common childhood infections
Characteristics of otitis media?
Bulging erythematous tympanic membrane with impaired mobility
Epidemiology of otitis media?
- The peak incidence and prevalence of OM is during the 1st 2 yr of life
- More than 80% of children experience at least one episode of OM by the age of 3 yr
How to classify otitis media?
- Acute - less than 14 days
- Chronic - more than 14 days
Treatment of otitis media?
- Amoxicillin
- Ear wicking for chronic supurative otitis media
Local complications of otitis media?
- Hearing impairment
- mastoiditis
Intracranial complications of otitis media?
- Meningitis
- epidural abscess
- subdural abscess
- focal encephalitis
- brain abscess
- sigmoid sinus thrombosis
Importance of a patent airway in newborns?
Most newborn infants are obligate nasal breathers
1. Nasal obstruction presenting at birth may be life-threatening
2. Nasal passages contribute 50% of the total resistance
What are the causes of nasal congestion with obstruction in the 1st year of life?
- Viral or bacterial infection
- Enlarged adenoids
What is nasal flaring?
a sign of respiratory distress
- reduces the resistance to inspiratory airflow through the nose and can improve ventilation
Describe the nasal airway in children?
- Internal nasal airway doubles in size in the 1st 6months of life
- The lumen of an infant’s or child’s airway is narrow
- The area just below the vocal cords is the narrowest portion in <10year olds
Consequences of mucosal edema in a newborn?
Minor reductions in cross-sectional area due to mucosal edema or other inflammatory processes cause an exponential increase in airway resistance and a significant increase in the work of breathing
Supportive care in airway obstruction?
- Bulb syringe and saline nose drops
- Topical nasal decongestants, and antibiotics, when indicated, improve symptoms in affected infants
What is allergic rhinitis?
Inflammatory disorder of the nasal mucosa
Symptoms of allergic rhinitis?
- Nasal congestion
- rhinorrhea
- itching
Allergic rhinitis is associated with?
- conjunctivitis
- sinusitis
- otitis media
- serous otitis
- hypertrophic tonsils and adenoids
- eczema
Causes of obstruction of the pharyngeal airway?
Enlarged tonsils, adenoids, tongue, or syndromes with midface hypoplasia
- Worse during sleep than during waking.
Describe features of laryngeal, tracheal or bronchial obstruction?
Worse when awake, exacerbated by exertion
What is choanal atresia (bilateral)?
a congenital disorder in which the nasal choanae (paired openings that connect the nasal cavity with the nasopharynx) are occluded by soft tissue (membranous), bone, or a combination of both due to failed recanalization of the nasal fossae during fetal development
Symptoms of choanal atresia?
- Respiratory distress
- cyanosis
- worse with feeding - relieved by crying
Diagnosis of choanal atresia?
- Inability to pass a catheter through each nostril 3-4cm into the nasopharynx.
- Direct visualization with fiberoptic rhinoscopy.
- CT
Treatment of choanal atresia?
- Oral airway
- Drilling
- Stents are left in place for weeks after the repair to prevent closure or stenosis
Tonsilitis?
inflammation of the tonsils (2 oval shaped pads of tissue at the back of the throat)
- usually caused by a viral infection but can be from a bacterial infection
e.g. group A streptococcus
Adenoiditis?
an inflammation of the adenoids caused by infection
Symptoms of inflammation of tonsils and adenoids?
- Chronic mouth breathing
- Nasal obstruction
- Hyponasal speech
- Hyposmia and decreased appetite
- Poor school performance
(Rarely: symptoms of right-sided heart failure) - Nighttime symptoms consist of loud snoring
Treatment of tonsils and adenoids?
Tonsillectomy and adenoidectomy
Who usually gets foreign body obstruction of upper airway? Why?
Risk greatest in 6 months-4 years old
History of:
1. Children running with food
2. Small toy/objects in mouth
3. Poor household “childproofing”
4. Older siblings feeding younger children age-inappropriate food
Signs of foreign body obstruction of upper airway?
Acute onset of;
1. cyanosis
2. drooling
3. cough
4. stridor
Sign of foreign body obstruction of lower airway?
- Abrupt onset of cough, wheezing or respiratory distress
- Signs may decrease of disappear with time - May cause bronchiectasis if untreated
Note: Suspect LRI obstruction in chronic or recurrent “pneumonias”
What is heard on auscultation of a patient with foreign body obstruction of lower airway?
- Asymmetric breath sounds or
- Localized wheezing or
- Localized rales/crepitations
What is foreign body aspiration?
when a foreign body enters the airway which can cause difficulty breathing or choking - when an object enters the respiratory tract it is termed aspiration
Where are objects commonly lodged in FBA?
in the right main bronchus because of its straight course
Management of FB aspiration?
- Removal by rigid bronchoscopy
Followed by: - Adrenaline nebulizations
- physiotherapy
Bacterial causes of airway obstruction?
- Diphtheria
- Bacterial tracheitis
- Epiglottitis
- Mycoplasma pneumoniae (atypical)
Viral causes of airway obstruction?
- Parainfluenza viruses (types 1, 2, and 3)
-75% of cases - Influenza A and B
- Adenovirus
- Respiratory syncytial virus (RSV)
- Measles.
What is croup?
an upper airway infection that blocks breathing and has a distinctive barking cough
Clinical signs of croup?
- Stridor
- barking cough
- mild fever
- hoarseness
- worse at night
- URI
What age do children get croup?
6 mo – 3 yr
Causes of croup?
Parainfluenza (other viruses)
Management of croup?
- Adrenaline nebulization ± brief steroid use
- Oral or inhaled corticosteroids may be administered to decrease the severity of symptoms and potentially avoid hospital admission - Intubation is necessary when disease is severe.
- In children with atypical, prolonged, or recurrent symptoms refractory to medical therapy, bronchoscopy may be helpful for further evaluation.
What is epiglottitis?
inflammation of the epiglottis caused by an infection causing swelling which blocks air to the lungs
Clinical signs of epiglotittis?
- Abrupt onset
- toxic
- anxious
- high fever
- drooling
- dysphagia rare cough
Age group that usually gets epiglottitis?
3 - 7 years
Causes of epiglotittis?
H influenza B
Diagnosis and management of epiglottitis?
- Direct visualization by experienced clinician
- intubation
- i.v antibiotics
- ICU
Retropharyngeal abscess?
bacteria grow in the retropharyngeal lymph nodes
Clinical signs of retropharyngeal abscess?
- Acute pharyngitis
- high fever
- toxic
- dysphagia
- hyperextension of head
- drooling
Causes of retropharyngeal abscess?
Group A strep, staph aureus, Anaerobes
Diagnosis of retropharyngeal abscess?
- Visualization
- lateral neck x-ray
- i.v antibiotic, surgery
Clinical signs of retropharyngeal abscess?
- Sudden onset of fever
- stiff neck
- dysphagia
- occasionally stridor
- Follows a recent pharyngitis or upper respiratory tract infection
Bacterial tracheitis?
bacterial infection of the trachea causing stridor and dyspnea
Clinical signs of bacterial tracheitis?
- Croup-like illness
- high fever
- toxic
What age group ususally gets bacterial tracheitis?
< 6 years
Causes of bacterial tracheitits?
S. aureus
Diagnosis of bacterial tracheitis?
- Visualization
- lateral neck x-ray
- nebulized adrenaline
- IV antibiotics
Exudative tracheitis?
- Affected children are usually older (6-10years)
- More ill than those with standard croup
Causes: Staphylococcus aureus,Hib, pneumococcus
Differential diagnosis of URT obstruction?
- Bacterial tracheitis
- Diphtheritic croup
- Measles Croup
- Foreign body
- Retropharyngeal or peritonsillar abscess
- Extrinsic compression
e.g. laryngeal web, vascular ring - Intraluminal obstruction
e.g. laryngeal papilloma, subglottic hemangioma - Angioedema
e.g. anaphylaxis
Laryngeal papillomas?
- Most common respiratory tract neoplasms in children
- Occurs in 4.3/100,000
- They are warts—benign tumors—caused by the human papillomavirus (HPV)
- 50% of recurrent respiratory papillomatosis (RRP) occur in children <5yr
- 67% RRP have mothers with condylomata during pregnancy or parturition
- The risk for transmission is ∼1/500 vaginal births in mothers with active condylomata
Clinical presentation of laryngeal papilloma’s?
- Chronic hoarseness in infants
- Most occur in the larynx
- 31% nose, pharynx, trachea, bronchi, and lungs - Progressive hoarseness and communication difficulties
- Respiratory distress develops
- Obstructive sleep apnea
Treatment of laryngeal papillomas?
Treatment of RRP is endoscopic surgical removal
Examples of Congenital Causes of Airway Obstruction?
- Laryngomalacia
- Congenital Subglottic stenosis
- Vocal cord paralysis
- Congenital laryngeal webs and atresia
- Congenital subglottic hemangioma
Laryngomalacia?
- The most common congenital laryngeal anomaly
- The most common cause of stridor in infants and children
- 60% of congenital laryngeal anomalies with stridor are due to laryngomalacia
Symptoms of laryngomalacia?
- Stridor is exacerbated by any exertion: crying, agitation, or feeding
- Stridor results from the collapse of supraglottic structures inwards during inspiration
- Symptoms usually appear within the first 2wk of life and increase in severity for up to 6mo
- Gradual improvement can begin at any time
Treatment of laryngomalacia?
- Expectant observation - suitable for most infants
- Most symptoms resolve spontaneously
- Endoscopic supraglottoplasty for few patient with severe obstruction
Differential diagnosis of stridor in an infant?
- Laryngomalacia
- Laryngeal cyst, haemangioma or web
- Laryngeal stenosis
- Vocal cord paralysis
- Vascular ring
- Gastro-oesophageal reflux
- Hypocalcaemic (laryngeal tetany)
- Respiratory papillomatosis
- Subglottic stenosis
