Upper airway obstruction

Kumar, S. and Salib, R. (2006) Upper airway obstruction. In, Encyclopedia of Respiratory Medicine: Volume 1-4. Elsevier, V4-375-V4-385. (doi:10.1016/B0-12-370879-6/00415-4).

Abstract

The upper airway extends from the nasal passages to the lower end of the cricoid cartilage (subglottis). The causes of upper airway obstruction can be classified in many ways, including pathological and anatomical. Symptoms and signs vary according to the site of obstruction and whether it is acute or chronic in nature. Common symptoms include nasal blockage, snoring, shortness of breath, coughing, and choking. The signs are dependent on the cause and can include stridor, abnormal voice, confusion, restlessness, cyanosis, use of accessory muscles, and suprasternal recession. Common causes include foreign bodies, inflammatory/infective conditions, and neoplastic disease. Diagnosis of the cause of the obstruction requires an accurate history and examination, including visualization of the upper airway from the nasal vestibules to the subglottic larynx using flexible fiber-optic endoscopy. In the acute situation, arterial blood gases may help to quantify the extent of the hypoxia and any associated acid-base imbalance. Radiological investigations, including plain neck/chest X-rays and computerized tomographic scans, can be useful in selected cases. Therapeutic options depend on the etiological agent and the acuteness of onset. The priority in acute obstruction should always be securing of the airway either medically or surgically followed by treatment of the underlying cause. In chronic cases, the emphasis is more on investigating and treating the underlying cause. Upper airway obstruction is a serious and potentially life-threatening condition and as such requires prompt assessment and management.

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Contributors

Author: R. Salib

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