Untitled Quiz

Upper Airway Disorders in Pediatrics

• Upper airway disorders affect the nasal cavity, paranasal sinuses, pharynx, and larynx.
• These disorders can be caused by mechanical obstruction (e.g., foreign body aspiration, structural defects like laryngomalacia) or inflammation.

Intended Learning Objectives

• Identify various upper airway disorders in pediatric patients.
• Describe the clinical presentation of each disorder.
• Differentiate between different upper airway disorders.
• Understand management options for upper airway disorders in pediatrics.

Mechanical Upper Airway Obstruction

• Laryngeomalacia is a congenital abnormality of the laryngeal cartilages.

• Shortened aryepiglottic folds cause laryngeal shape to obstruct airflow.

• Symptoms include inspiratory stridor, worse in supine position, and difficulty breathing. Symptoms peak in the first few weeks after birth, and peak again around 6 months, and often resolve by 12-18 months old.

• Diagnosis may involve laryngoscopy or bronchoscopy to visualize the airway.

• Foreign body aspiration is a common cause of airway obstruction.

• Objects lodged in the airway create breathing difficulties which can range from moderate to severe breathing distress.

• Symptoms can include choking, coughing, drooling, gagging, and inspiratory stridor.

• Prompt diagnosis and intervention are crucial.

Foreign Body Aspiration

• Larynx is the most common site in children age 1 year
• Trachea or right mainstem bronchus in children age >1 year
• In the nose, symptoms include unilateral, foul-smelling rhinorrhea and epistaxis.
• Symptoms of partial obstruction can include coughing, drooling, and inspiratory stridor.
• Symptoms of complete obstruction include inability to cough, speak, and pass out.
• Diagnosis can be done via chest x-ray or CT scan to view the lodged object.
• Laryngoscopy is used to visualize and remove the foreign body.
• Basic life saving maneuvers are critical for infants

Acute Inflammatory Upper Airway Obstruction

• Rhinitis, sinusitis, pharyngitis, epiglottitis, and laryngitis are common inflammatory conditions.

• Rhinitis: can be allergic or infectious. Infectious rhinitis is caused by viruses (rhinovirus, influenza, RSV, parainfluenza, adenovirus) or bacteria (Streptococcus pneumoniae, Haemophilus influenzae, Moraxella catarrhalis, Staphylococcus aureus).

• Sinusitis: Caused by S. pneumoniae, H. influenzae, M. catarrhalis. Predisposing factors include immune deficiency, ciliary dysfunction, cleft palate, nasal polyps, foreign body, URI, allergy, and cigarette smoke.

• Pharyngitis: typically uncommon in children under age 3; more common in 3-14 year olds. Caused by viruses (rhinovirus, coronavirus) or bacteria (group A Streptococcus).

• Epiglottitis: a serious infection of the epiglottis. Caused by bacteria such as Streptococcus pyogenes, Streptococcus pneumoniae, Staphylococcus aureus, and Mycoplasma; and Haemophilus influenzae type B (HiB). Risk factors include adults and unimmunized children. Toxic appearance, high fever, sore throat, difficulty swallowing, drooling and progressive dyspnea (difficult breathing and shortness of breath). Can lead to complete airway obstruction.

• Laryngitis: inflammation of the larynx. Common causes include viruses such as parainfluenza viruses 1, 2, and 3. More common in winter.

Otitis Externa (Swimmer's Ear)

• Causes include excessive wetness, dryness, skin pathology, and trauma.
• Symptoms include significant pain (especially with manipulation), conductive hearing loss, edema, erythema, thick otorrhea, and preauricular nodes.

Otitis Media

• Common in the first 2 years of life.
• Etiology: bacterial (pneumococcus, nontypeable H. influenzae, Moraxella catarrhalis) and viral.
• Risk factors include low socioeconomic status, lack of breast milk, tobacco smoke, exposure to other children, cold weather, and other congenital anomalies (palatal clefts, Down syndrome). inflammation causes middle ear effusion. Clinical findings may be variable.
• Pneumatic otoscopy is critical for diagnosing. The mobility of the tympanic membrane (eardrum) is assessed.

Other relevant information

• The images shown are medical illustrations and x-rays related to pediatric upper airway diseases.
• These notes summarize information from the provided images and text.