Presentation
OBJECTIVES: To determine the clinical presentations and management of patients with acute laryngeal obstruction. [ncbi.nlm.nih.gov]
A rationalisation of the 1350 boxes used throughout the book gives a simpler and clearer presentation of the various categories. [books.google.com]
We suggest that this unusual presentation of laryngeal carcinoma may be due to the unusual histologic features of the tumor. [peertechz.com]
Entire Body System
- Weakness
Pulse is rapid, irregular, weak and thready. B.P. drops. [slideplayer.com]
Patients with a unilateral vocal cord paralysis present with a weak cry and biphasic stridor that is louder when awake and improves when lying with the affected side down. Bilateral vocal cord paralysis is a more serious entity. [emedicine.medscape.com]
These respiratory effects are typically preceded by other symptoms including fear, weakness, increased sweating, sneezing, urticaria, erythema and angio-oedema. The signs of shock can then follow rapidly. [patient.info]
Peritonsillar abscess (collection of infected material near the tonsils) Poisoning from certain substances, such as strychnine Retropharyngeal abscess (collection of infected material in the back of the airway) Severe asthma attack Throat cancer Tracheomalacia (weakness [medlineplus.gov]
Tracheomalacia Tracheomalacia is a weakness in the walls of the trachea. Issues to note: Inadequate cartilaginous support of the trachea leads to collapse in expiration. [www2.health.vic.gov.au]
- Foreign Body Aspiration
Upper airway obstruction [ edit ] Causes of upper airway obstruction include foreign body aspiration, blunt laryngotracheal trauma, penetrating laryngotracheal trauma, tonsillar hypertrophy, paralysis of the vocal cord or vocal fold, acute laryngotracheitis [en.wikipedia.org]
Risk factors for foreign body aspiration in adults include diminished level of consciousness; impaired swallowing mechanism or diminished upper airway sensation as a result of neuromuscular disorder, prior cerebrovascular accident, or advanced age; and [accessmedicine.mhmedical.com]
Body Aspiration Sedation, sleep, medication effect leading to poor upper airway tone Figure 3: Laryngomalacia (noted dynamic inspiratory collapse) Figure 4: Epiglottitis as seen with laryngoscopy and classic "thumb sign" on lateral neck XR Figure 5: [learnpicu.com]
It was reported in one study that only 11% of foreign bodies were radiopaque. 43 Other findings on AP films that are suggestive of a foreign body include hyperinflation, an infiltrate distal to the foreign body, or atelectasis if the aspirated item lodges [ahcmedia.com]
- tetanus Mechanical causes Foreign body aspiration Infections epiglottitis supraglottitis retropharyngeal cellulitis or abscess parapharyngeal abscess Ludwig�s angina diphtheria bacterial tracheitis laryngotracheobronchitis Laryngeal oedema allergic [aic.cuhk.edu.hk]
- High Fever
Other possible diagnoses Symptoms Possible Diagnosis High Fever Hyperextension of neck Dysphagia, pooling of secretions in throat epiglottitis retropharyngeal / peritonsillar abscess "Toxic" appearing child Markedly tender trachea bacterial tracheitis [rch.org.au]
Clinically, the patient experiences an abrupt onset of high-grade fever, sore throat, dysphagia, and drooling. [emedicine.medscape.com]
Stridor is a loud, harsh, high pitched respiratory sound. It may start as low-pitched 'croaking' and progress to high-pitched 'crowing' on more vigorous respiration. [patient.info]
Patients typically present to medical care within 12-48 hours from the onset of symptoms, with high fever (40° C), and complain of sore throat and respiratory distress. [ahcmedia.com]
Respiratoric
- Cough
The hemorrhagic lesions appeared to be induced by coughing due to bronchitis for which the penicillin was given. [ncbi.nlm.nih.gov]
A barking, seal-like cough, low fever and worse at night. Inhaled foreign body: Common, especially in children aged 1 to 2 years. Preceded by choking or coughing. Tracheitis: Uncommon cause. Usually occurs under the age of 3 years. [patient.info]
Assessment A harsh, barking cough in a febrile, miserable, but otherwise well child suggests Croup. Absent cough with low pitched expiratory stridor (often snoring) and drooling suggests epiglottitis. [rch.org.au]
[…] experience the following symptoms: Shortness of breath Chest and/or throat tightness Feeling they are "breathing through a straw" Stridor/wheezing Difficulty with inhalation and/or exhalation Frequent throat clearing Intermittent hoarseness Chronic cough [nationaljewish.org]
- Dyspnea
But slight inspiratory dyspnea and stridor may occur during crying or on exertion 5 Laryngeal obstruction classification: Ⅱ°slight inspiratory dyspnea during quiet respiration, and exaggeration on exertion. [slideplayer.com]
Exercise-induced laryngeal obstruction is a cause of exercise-induced dyspnea. [healio.com]
KEYWORDS: Athlete; dyspnea; exercise; larynx; swimming [ncbi.nlm.nih.gov]
- Hoarseness
A boy with junctional epidermolysis bullosa died from acute laryngeal obstruction at the age of 29 months, having been hoarse since early infancy. [ncbi.nlm.nih.gov]
Although their usual presenting symptom is hoarseness, acute airway obstruction from laryngeal polyps is uncommon. [academic.oup.com]
[…] with VCD and EILO may experience the following symptoms: Shortness of breath Chest and/or throat tightness Feeling they are "breathing through a straw" Stridor/wheezing Difficulty with inhalation and/or exhalation Frequent throat clearing Intermittent hoarseness [nationaljewish.org]
- Laryngeal Disease
Abstract The aim of this study was to find out if laryngeal obstruction could be assessed by measuring the glottic area using computed tomography (CT). Results from model studies were compared with those from twelve patients with laryngeal diseases. [ncbi.nlm.nih.gov]
Gastrointestinal
- Choking
The Heimlich maneuver This is an emergency technique that may help a person who is choking on a foreign object: The maneuver involves one person standing behind the person who is choking, wrapping their arms around the choking person’s waist. [healthline.com]
Other symptoms (cough, aspiration, drooling, choking, cyanosis, sleep). Severity (colour change, respiratory effort, apnoea). Perinatal history. Developmental history. Vaccination history. Growth and weight gain. [patient.info]
Sudden onset in an otherwise well child with coughing, choking and aphonia suggests an inhaled foreign body. Swelling of face and tongue, wheeze or urticarial rash suggests Anaphylaxis. [rch.org.au]
- Gagging
Cannot be used in awake patients, as it causes them to gag and potentially vomit. [learnpicu.com]
There may also be paroxysmal coughing, gagging or choking, hoarseness, wheezing, tachycardia and other signs of respiratory distress. Patients are usually anxious and distressed. Narrowing above the larynx causes stridor. [patient.info]
[…] relieved within 2-5 minutes of the onset partial UAO: stable, or progressive deterioration signs and symptoms may be mild but as they worsen include coughing, inspiratory stridor, crowing or noisy respiration, dysphonia, aphonia, choking, drooling and gagging [aic.cuhk.edu.hk]
- Abdominal Pain
pain common causative agents are Hymenoptera stings, shellfish ingestion and drugs angiotensin converting enzyme inhibitor therapy related angioedema is becoming more common as the number of patients receiving this therapy increases treatment consists [aic.cuhk.edu.hk]
Jaw & Teeth
- Trismus
The patient develops severe throat pain, trismus, and trouble with swallowing or speaking. Spasmodic croup, also termed acute spasmodic laryngitis, occurs most commonly in children aged 1-3 years. The presentation may be identical to that of croup. [emedicine.medscape.com]
Peritonsillar abscess presents with trismus, difficulty with swallowing and difficulty with speaking. Anaphylaxis : Hoarseness and inspiratory stridor. Accompanied by other symptoms of an allergic reaction. [patient.info]
Another classic finding in peritonsillar abscess is trismus of the internal pterygoid muscle of the face. [ahcmedia.com]
Cardiovascular
- Chest Pain
pain, palpitations, haemoptysis, and the presence of cardiac signs such as a cardiac murmur. [bjgp.org]
- Hypotension
Heart rate and blood pressure raised Patient becomes rapidly cyanosed respiratory efforts diminish, loss of consciousness, bradycardia and hypotension cardiac arrest death is inevitable if the obstruction is not relieved within 2-5 minutes of the onset [aic.cuhk.edu.hk]
Skin
- Angioedema
The author considers the following six types: acute laryngotracheobronchitis, acute epiglottitis, diphtheria, supraglottic allergic edema (angioedema), subglottic allergic edema (spasmodic croup) and foreign body in the larynx or trachea. [ncbi.nlm.nih.gov]
Angioedema from angiotensin-converting enzyme inhibitors may occur at any time during the course of therapy. [accessmedicine.mhmedical.com]
Hereditary Angioedema. Hereditary angioedema (HAE) is an uncommon cause of angioedema and classically presents without the characteristic pruritus and urticaria seen in allergic causes of angioedema such as anaphylaxis. [ahcmedia.com]
Mechanical causes Foreign body aspiration Infections epiglottitis supraglottitis retropharyngeal cellulitis or abscess parapharyngeal abscess Ludwig�s angina diphtheria bacterial tracheitis laryngotracheobronchitis Laryngeal oedema allergic hereditary angioedema [aic.cuhk.edu.hk]
Angioedema Use of corticosteroids, antihistamines, H1 and H2 blockers, and subcutaneous epinephrine may alleviate angioedema due to ACE inhibitors or laryngeal edema due to other agents. [clinicaladvisor.com]
Musculoskeletal
- Fracture
CAUSES Foreign body Infection Epiglottis Retropharyngeal abscess Bacterial tracheitis Ludwig’s angina Laryngotracheitis Diptheria Tetanus Immune Angioedema Anaphylaxis Tumor Trauma Neck hematoma, e.g. trauma, bleeding diathesis, anticoagulants laryngeal fracture [lifeinthefastlane.com]
A standard 6-6.5 endotracheal tube could also be used. commercially available percutanous tracheostomy sets (Cook) that meet above requirements are available. complications (eg subglottic stenosis, thyroid fracture, haemorrhage and pneumothorax) uncommon [aic.cuhk.edu.hk]
Contraindicated with CSF leaks/basilar skull fractures Oropharyngeal Tube: Used to assist bag mask ventilation when there may be poor pharyngeal tone or a large tongue leading to obstruction. [learnpicu.com]
Workup
RESULTS: Of 88 athletes who completed a full workup, 31 (35.2%) had EILO and 38 (43.2%) had a positive bronchoprovocation or bronchodilator reversibility test. [ncbi.nlm.nih.gov]
Treatment
In case of severe supraglottic collapse and pronounced symptoms during strenuous exertion, surgical treatment (supraglottoplasty) has been suggested. [ncbi.nlm.nih.gov]
Finally circulatory collapse may occur or may die of asphyxia or cardiac failure. 8 Laryngeal obstruction Treatment Ⅰ°:etiological treatment, antibiotics and corticosteroid. 9 Laryngeal obstruction Treatment Ⅱ°:etiological treatment. in case of tumors [slideplayer.com]
The patients reported a better ability to breathe while exercising, after surgical treatment, as revealed by VAS scores. [bora.uib.no]
Treatment General approach There are currently no published randomised controlled treatment trials. [erj.ersjournals.com]
Severe or refractory asthma places a significant burden on the patient and often requires treatment with systemic glucocorticoids, which have significant side effects. [figshare.com]
Prognosis
Overall prognosis is considered considered generally poor 6. tracheal atresia Promoted articles (advertising) [radiopaedia.org]
The prognosis is poor with squamous cell carcinoma of the trachea, which carries a 5-year survival of approximately 40% when resectable and 7% when unresectable. [clinicaladvisor.com]
PMID: 29631737 Prognosis Solomon NP, Pham A, Gallena S, Johnson AT, Vossoughi J, Faroqi-Shah Y J Voice 2022 Sep;36(5):734.e1-734.e6. Epub 2020 Sep 26 doi: 10.1016/j.jvoice.2020.09.002. [ncbi.nlm.nih.gov]
[…] especially when being prepared for children Consume food slowly and fully chew food before swallowing, which is an effective preventative method Closely watch very young children while they play with toys and small play items (toy parts) What is the Prognosis [dovemed.com]
Prognosis of EILO It has been suggested that laryngeal growth and maturation during puberty should make the larynx more robust to inward forces at high minute ventilation [ 61 ]. [link.springer.com]
Etiology
Finally circulatory collapse may occur or may die of asphyxia or cardiac failure. 8 Laryngeal obstruction Treatment Ⅰ°:etiological treatment, antibiotics and corticosteroid. 9 Laryngeal obstruction Treatment Ⅱ°:etiological treatment. in case of tumors [slideplayer.com]
CONCLUSIONS: In athletes with unexplained respiratory symptoms, EILO is an important differential diagnosis not discerned from other etiologies by clinical features. [ncbi.nlm.nih.gov]
The etiology is unknown, although sporadic, genetic (3) and vascular causes (4) have all been proposed. [fetalultrasound.com]
Epidemiology
This review of the literature provides an overview of the current understanding of the definition, epidemiology, diagnosis and management of EILO. [ncbi.nlm.nih.gov]
Epidemiology The reported epidemiology of ILO varies considerably, depending on the diagnostic criteria employed ( table 2 ). [erj.ersjournals.com]
Biphasic stridor suggests subglottic or glottic obstruction. [ 1 ] Epidemiology The detailed epidemiology of stridor depends on the cause, but it is worth noting the following patterns of disease: Stridor is common in younger children with smaller airways [patient.info]
Pathophysiology
Specifically, our understanding of the aetiology and pathophysiology remain poor and despite considerable technological advances, robust, validated, diagnostic and treatment algorithms are yet to be established. [erj.ersjournals.com]
See Figure 2 for a comparison of what 1 mm of circumferential edema does in terms of airway resistance to an infant and an adult Pathophysiology Upper airway obstruction can occur for a variety of causes, but fundamentally, leads to increased airway resistance [learnpicu.com]
Gavin Joynt Pathophysiology - obstruction is likely to occur at sites of anatomic narrowing such as the hypopharynx at the base of the tongue and the false and true vocal cords at the laryngeal opening. - sites of airway obstruction are referred to as [aic.cuhk.edu.hk]
Palliative interventions for patients with chronic upper airway obstruction include: balloon dilatation airway stenting laser therapy electrocautery and argon plasma coagulation cryotherapy nocturnal, noninvasive, positive-pressure ventilation Pathophysiology [clinicaladvisor.com]
Prevention
The primary physician must know when and where to send these children in order to prevent the fatalities so frequent in previous years. [ncbi.nlm.nih.gov]
Prompt evaluation and management of suspected UAO may prevent subsequent complications including cardiac arrest, anoxic brain injury, and negative pressure pulmonary edema. [accessmedicine.mhmedical.com]
Airway secretions, edema, and downward folding of the epiglottis cause complete laryngeal obstruction, preventing endotracheal intubation. [anatomicaljustice.com]
There are no definitive methods to prevent Acute Upper Airway Obstruction. However, proper precautions may be taken to reduce risks. [dovemed.com]
The American Thoracic Society and the European Respiratory Society define refractory asthma as asthma that requires treatment with high-dose inhaled corticosteroids (ICS) plus a second controller and/or systemic corticosteroids to prevent it from becoming [figshare.com]