Upper airway obstruction.

Abstract

1. Jordan Virbalas, MD* 2. Lee Smith, MD† 1. *Department of Otorhinolaryngology–Head and Neck Surgery, Albert Einstein College of Medicine, Bronx, NY. 2. †Department of Otolaryngology, Steven and Alexandra Cohen Children’s Medical Center, Hofstra North Shore LIJ School of Medicine, New Hyde Park, NY. * Abbreviations: BT: : bacterial tracheitis CT: : computed tomography HIB: : Haemophilus influenzae type B The differential diagnosis of upper airway obstruction in children includes infectious and noninfectious causes (Table). When evaluating a child with stridor, the clinician must know how to differentiate between various anatomical anomalies (laryngomalacia, tracheomalacia, and subglottic stenosis) and infectious conditions (croup, epiglottitis, and bacterial tracheitis) to promptly implement appropriate management. View this table: Table. Common Causes of Upper Airway Obstruction After completing this article, readers should be able to 1. Know that upper respiratory tract infections and airway obstruction in young infants can lead to respiratory distress. 2. Know the clinical presentation of laryngomalacia. 3. Know the risks of examination of patients with suspected epiglottitis. 4. Know how to treat a child with epiglottitis. 5. Know the clinical manifestations of laryngotracheitis (croup). 6. Know the appropriate management of croup. 7. Differentiate the clinical and radiographic findings of viral croup from those of epiglottitis and bacterial tracheitis. 8. Distinguish between viral and noninfectious croup. 9. Recognize the signs and symptoms of bacterial tracheitis. 10. Know the typical clinical course of bacterial tracheitis, including biphasic illness, precipitous worsening, requirement for intubation, and relatively prolonged intubation. 11. Know the treatment of bacterial tracheitis. 12. Know the microbiology of bacterial tracheitis. 13. Know that tracheomalacia can occur as a complication of long-term mechanical ventilation in children. 14. Know that tracheoesophageal fistula may result in tracheomalacia. 15. Know the clinical manifestations of tracheomalacia. ### Definitions Laryngomalacia refers to the prolapse of supraglottic structures into the laryngeal airway on inspiration, which usually manifests as a primarily inspiratory stridor in young children. ### Introduction Laryngomalacia is the most common congenital laryngeal anomaly and is the most frequent congenital cause of stridor in infants. Often symptoms are not present at birth, and affected children typically develop stridor in the first 2 …