13.03.01 ENT - Airway obstruction

Noises

• • Stridor

    • Inspiratory

      • Obstruction is above the vocal cords

    • Biphasic

      • Obstruction is at the level of the vocal cords

    • Expiratory

      • Obstruction is just below the vocal cords

  • Sturtor

    • Obstruction in oropharynx

      • Tongue swelling

      • Ludwig's angina

      • Anaphylaxis

      • Angioedema

  • Wheeze

    • Lower airway obstruction

Causes of stridor in a child

• • Croup

    • 2-4 years

    • Parainfluenza virus

  • Laryngomalacia

    • Most common cause in infancy

    • Esp. <2 yrs

    • Soft, immature cartilage of the upper larynx collapses inward during inhalation

    • Exacerbated by reflux

  • Laryngospasm

  • Long intubation

    • => Granuloma formation => Subglottic stenosis

  • Vocal nerve palsy

Laryngeal nerve

• • Left branch loops under the aorta

    • Lower + longer => More risk of damage

  • Right branch loops under the right subclavian artery

Tracheostomy

• • Between second and third tracheal rings

  • Be careful not to do it through a tumour => Spread/Poor prognosis