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Upper Airway Problems in Daily Practice
Rangga Rayendra Saleh
Department of Otorhinolaryngology - Head and Neck Surgery
Cipto Mangunkusumo Hospital Faculty of Medicine Universitas Indonesia
Overview
• Introduction
• Anatomy and physiology
• Most Common Cases Diagnosis and Management
• Conclusion
Upper Airway
• Upper airway consists of:
• Nose
• Nasopharynx
• Oropharynx
• Larynx
• Continuous passage from nostrils to lungs
• Interaction with lower airway: United
Airway concept
Nose
• External : bony & cartilage part• Internal: divided by nasal septum• Lateral wall:
• Nasal turbinates • Ostium of paranasal sinuses
• Mucosa: ciliated pseudostratified glandular columnar epithelium• Mucociliary transport
Mucociliary transport of the nose and paranasal sinuses
Oropharynx
• Connects nasopharynx and
hypopharyx/larynx
• Bounded anteriorly by the
papillae of the tongue and
anterior tonsillar pillars
• Consists of: tongue base,
palatine tonsils, soft palate, and
oropharyngeal mucosa and
constrictor muscles
Larynx
• Located in the anterior neck
• Functions:
• Phonation
• Cough reflex
• Protection of the lower
respiratory tract
• Primarily cartilaginous
Most common cases
• Acute/Chronic Rhinosinusitis
• Acute/Chronic Tonsilopharyngitis
Acute Rhinosinusitis
Acute Rhinosinusitis
• Rhinitis and sinusitis usually coexist and concurrent
• Affecting 6 - 15% of the population
• Acute rhinosinusitis in adults:
• Sudden onset of two or more symptoms, one of which should be either nasal
blockage/obstruction/congestion or nasal discharge (anterior/posterior nasal drip:
• + facial pain/pressure
• + reduction or loss of smell
• For < 12 weeks, with symptom free intervals if it is recurrent
Acute Rhinosinusitis
• Acute rhinosinusitis in children:
• Sudden onset of two or more of the symptoms:
• Nasal blockage/obstruction/congestion
• Or discoloured nasal discharge
• Or cough (daytime or night time)
• For < 12 weeks, with symptoms free intervals if it is recurrent
Classification of ARS in
adult and children
• Common cold/acute viral
rhinosinusitis: <10 days
• Acute post viral rhinosinusitis:
increase of symptoms after 5 days or
persistent >10 days and < 12 weeks
Classification (2)
• Acute bacterial rhinosinusitis:
• Presence of at least 3 sign/symptoms of:
• Discoloured discharge (with unilateral predominance)
• Severe local pain (with unilateral predominance
• Fever (>38)
• Elevated ESR/CRP
• Double sickening
• Etiology: Streptococcus pneumoniae, Haemophilus influenza, Moraxella catarrhalis, Staphylococcus
aureus
Nasal saline irrigation
Medication
• Decongestants:
• Oral decongestants: usually combined with antihitamine
• Topical decongestants: alpha blocker
• Topical steroids
• Antibiotics (for selected cases)
• Amoxicillin clavulanate (3 x 625 mg 7 - 10 days)
• Azithromycin (1x500 mg 3 days)
• Levofloxacin (1x500 mg 10 days)
Chronic Rhinosinusitis
(with or without nasal polpyps)
Chronic Rhinosinusitis
• Definition:
• Inflammation of the nose and paranasal sinuses, characterised by two or more symptoms, one of which should be either nasal
blockage or nasal discharge
• + facial pain/pressure
• + reduction or loss of smell
• For > 12 weeks
• Either endoscopic signs of
• Nasal polyps and/or
• Mucopurulent discharge from middle meatus
• Mucosa obstruction in middle meatus
• And/or CT changes : ostiomeatal complex
Tonsilitis & pharyngitis
Tonsilitis and Pharyngitis
• Inflammation of the tonsils and posterior
pharyngeal wall
• Might coexist or happens individually
• Most common cause: viral infection
• Signs and symptoms:
• Odinophagia
• Cough
• Headache
• Detritus
• Swollen tonsils
Viral vs Bacterial Infection
Centor Score
Management
• Viral infection:
• Antibiotics are not indicated
• Symptomatic treatment
• Antiseptic lozenges and antibacterial mouthwash are not recommended
• Bacterial infection:
• Delay treatment until culture confirms diagnosis
• Empiric treatment for several conditions
• Group A streptococcal infection: 10 days antibiotics
Surgery for Chronic Tonsillitis
Conclusion
• Upper airway is a continuous passage that correlate with the lower airway
(United airway concept)
• History taking and physical examination: important to determine viral or
bacteria infection
• Antibiotics should be reserved only for confirmed bacterial infection
• Irrational use of antibiotics will increase microorganism resistance and cost
Thank You