Diagnosis Of Upper Airway Obstruction Research Articles

Deep Learning for Automatic Upper Airway Obstruction Detection by Analysis of Flow-Volume Curve

Background: Due to the similar symptoms of upper airway obstruction to asthma, misdiagnosis is common. Spirometry is a cost-effective screening test for upper airway obstruction and its characteristic patterns involving fixed, variable intrathoracic and extrathoracic lesions. We aimed to develop a deep learning model to detect upper airway obstruction patterns and compared its performance with that of lung function clinicians. Methods: Spirometry records were reviewed to detect the possible condition of airway stenosis. Then they were confirmed by the gold standard (e.g., computed tomography, endoscopy, or clinic diagnosis of upper airway obstruction). Images and indices derived from flow-volume curves were used for training and testing the model. Clinicians determined cases using spirometry records from the test set. The deep learning model evaluated the same data. Results: Of 45,831 patients’ spirometry records, 564 subjects with curves suggesting upper airway obstruction, after verified by the gold standard, 351 patients were confirmed. These cases and another 200 cases without airway stenosis were used as the training and testing sets. 432 clinicians evaluated 20 cases of each of the three patterns and 20 no airway stenosis cases (n = 80). They assigned an accuracy of 41.2% (±15.4) (interquartile range: 27.5–52.5%), with poor agreements (κ = 0.12). For the same cases, the model generated a correct detection of 81.3% (p < 0.0001). Conclusions: Deep learning could detect upper airway obstruction patterns from other classic patterns of ventilatory defects with high accuracy, whereas clinicians presented marked errors and variabilities. The model may serve as a support tool to enhance clinicians’ correct diagnosis of upper airway obstruction using spirometry.

Clinical characteristics and outcomes of 111 neonates with upper airway obstruction admitted via transportation

Objectives: To analyze the clinical characteristics and outcomes of neonates with upper airway obstruction (UAO) who were admitted via transportation, hence to provide more evidence-based information for the clinical management of UAO. Methods: This was a single center retrospective study. Patients were hospitalized in Beijing Children's Hospital from January 1, 2016 to May 31, 2021 with age <28 days or postmenstrual age (PMA) ≤44 weeks, and UAO as the first diagnosis. The general information of patients, obstructed sites in the upper airway, treatment, complications and prognosis were analyzed. The outcomes of surgical UAO vs. non-surgical UAO were analyzed by 2 by 2 χ2 test. Results: A total of 111 cases were analyzed (2.3% of the total NICU hospitalized 4 826 infants in the same period), in which 62 (55.9%) were boys and 101 (91.0%) were term infants, and their gestational age was (38.7±2.0) weeks, birth weight (3 207±585) g, PMA on admission (40.8±2.5) weeks and weight on admission was (3 221±478) g. There were 92 cases (82.9%) with symptoms of UAO presenting on postnatal day 1, and 35 cases (31.5%) had extra-uterine growth retardation on admission. The diagnosis of UAO and the obstructive site was confirmed in 25 cases (22.5%) before transportation. There were 24 cases (21.6%), 71 cases (64.0%), and 16 cases (14.4%) who had UAO due to nasal, throat, and neck problems, respectively. The top 5 diagnosis of UAO were vocal cord paralysis (28 cases), bilateral choanal atresia (20 cases), laryngomalacia (15 cases), pharynx and larynx cysts (7 cases), and subglottic hemangioma (6 cases). The diagnosis and treatment of all the patients followed a multidisciplinary approach consisted of neonatal intensive care unit, ear-nose-throat department and medical image departments. A total of 102 cases (91.9%) underwent both bronchofiberscope and fiber nasopharyngoscope investigation. Seventy cases (63.1%) required ventilation. Among the 58 cases (52.3%) who required surgical intervention, 16 had tracheotomy. For cases with vs. without surgical intervention, the rate of cure and (or) improvement were 94.8% (55/58) vs. 54.7% (29/53), and the rate of being discharged against medical arrangement were 1.7% (1/58) vs. 45.3% (24/53) (χ²=24.21 and 30.11, both P<0.01). Conclusions: Neonatal UAO may locate at various sites of the upper airway. The overall prognosis of neonatal UAO is favorable. A multidisciplinary approach is necessary for efficient evaluation and appropriate surgical intervention.

Role of spirometry with flow volume loop in the diagnosis of upper airway obstruction: A study from the pulmonary medicine department of a tertiary care center

Role of spirometry with flow volume loop in the diagnosis of upper airway obstruction: A study from the pulmonary medicine department of a tertiary care center

Respiratory viral panels and pediatric airway evaluation: The role of testing for upper respiratory infections to stratify perioperative risk

ObjectivesChildren admitted with stridor and respiratory distress comprise a complex patient group that requires the otolaryngologist to decide when to assess and intervene with direct laryngoscopy and bronchoscopy (DLB). Historically, the diagnosis of viral upper respiratory tract infection (URTI) can lead to postponement of surgery due to concerns of perioperative complications related to acute illness. Respiratory viral panels (RVP) are often used to confirm the presence of recent or active viral infection and can affect the differential diagnosis of upper airway obstruction. This study examined whether positive RVP testing is associated with perioperative complications and operative findings in pediatric patients undergoing inpatient DLB. MethodsA retrospective chart review of 132 pediatric patient encounters was performed. Viral testing results, DLB indication, DLB findings, and perioperative complications were compared. ResultsSixty encounters (45.5%) involved a positive RVP, and 72 (54.5%) involved a negative RVP. Those with positive RVP were less likely to have a preoperative structural airway diagnosis (P =.0250) and more likely to have a history of recurrent upper respiratory infections (P =.0464). The most common reason for DLB was the need to assess the airway due to concern for structural pathology. Anatomic abnormalities were seen in a majority of encounters (77.3%) Laryngospasm occurred in 1 (1.7%) RVP positive and 1 (1.4%) RVP negative encounter, and 2 (2.8%) RVP negative encounters required reintubation. No other major complications were observed. No association was noted between RVP results and incidence of major or minor complication. ConclusionsMajor perioperative complications after surgical intervention with DLB for the management of complex, inpatient children with stridor and respiratory distress are rare. RVP positivity, specific pathogens identified on RVP, and presence of URI symptoms were not associated with perioperative complications.

Upper Airway Obstruction among the Paediatric Population in the University of Port Harcourt Teaching Hospital: The Place of Tracheostomy in the Management

Background: The paediatric age group has very peculiar anatomic and physiologic airways therefore, obstruction which commonly occurs in this population, can pose serious challenges in this age group.&#x0D; Aim: To study the pattern and aetiology of acute upper airway obstruction in the paediatric age group in University of Port Harcourt teaching hospital and to determine the place of tracheostomy in the management.&#x0D; Patients and Methods: It is a descriptive hospital based study of all paediatric patients; aged 0-15 years with upper airway obstruction that presented to the ear, nose and throat department and the children emergency ward of university of Port Harcourt teaching hospital within the period of January 2014 to December 2019. Data on demographics, clinical presentations, causes and management were obtained using a Proforma. The diagnosis of upper airway obstruction is made in a child with any degree of respiratory difficulty with or without associated stridor or stertor arising from lesions above the thoracic inlet. Children with respiratory difficulty other than that from an upper airway obstruction were excluded from the study.&#x0D; Data obtained were analyzed with the IBM statistical package for social sciences SPSS version 20. Results were presented in simple descriptive forms with tables.&#x0D; Results: One hundred and sixty paediatric patients with upper air way obstruction with age ranging from 0-15 years were studied. The prevalence of upper airway obstruction was 1.87%. There were more males than females; male to female ratio was 1.2:1. Age group 4-7 years were the most affected, 43.75%. Foreign body aspiration was the commonest cause. Majority of the patients had tracheostomy done, 48.75%. Mortality was n=1(0.625%).&#x0D; Conclusion: Upper air way obstruction among the paediatric age group is still common with foreign body aspiration as a very important cause in our setting. The very young are the most affected and tracheostomy appears to still be the main option of securing airway in these cases in our environment.

The clinical value of sleep endoscopy in the diagnosis of obstruction sites in patients with obstructive sleep apnea hypopnea syndrome: a systematic review and Meta-analysis

Objective:To investigate the clinical value of video laryngoscope in localization diagnosis of upper airway obstruction in OSAHS during drug-induced sleep.Method:We searched the MEDLINE (PubMed), EMBASE, CCTR (The Cochrane Controlled Clinical Trials Register Database), CNKI, WAN FANG databases for randomized, blinded studies according Cochrane systematic review. We chose articles published between 1975 and 2016 about the value of sleep endoscopy in localization diagnosis of upper airway obstruction in OSAHS. All the data were analyzed by the software of the Meta-Disc 1.4.Result:Seven qualitative studies and three quantitative studies were included.A total of three studies with 175 patients met the inclusion criteria for Meta-analysis. Meta-analysis results showed that the merger sensitivity degrees, specific degrees, diagnostic odds ratio, positive likelihood ratio, negative likelihood ratio and 95%CI were 1.0(0.96-1.0),0.71(0.59-0.81),212.47(36.07-1 251.56),4.40(1.28-15.16),and 0.02(0-0.11) respectively. The SROC area under the concentration-time curve (AUC) was 0.991 0.Conclusion:Because of its high accuracy, sleep endoscopy can be used as an important auxiliary examination and the sensitive indexes for the surgery procedures and prognosis treatment plan for OSAHS. But more cohort studies are needed for the verification.

Pulmonary Function after Adenotonsillectomy.

Adenotonsillar hypertrophy is a common disorder among children which, without proper treatment, may lead to considerable problems. Although the consequences of this disorder have been studied in other articles, we decided to evaluate the changes in pulmonary function tests in these children after adenotonsillectomy, and the correlation between clinical and spirometric parameters. We conducted a before- and after- clinical trial. Forty children (17 females and 23 males) with a diagnosis of upper airway obstruction due to adenotonsillar hypertrophy were enrolled in this study. Mean age of the participants was 6.9±1.9 years. Eight spirometric parameters were selected for evaluation pre-operatively and 40 days postoperatively. Besides, symptom scores were defined for each patient to assess their disease severity, pre- and postoperatively. Data were analyzed statistically. Forced vital capacity (FVC) increased from 1.28±0.26% pre-operatively to 1.33±0.24%postoperatively (P=0.05). Peak expiratory flow increased from 2.74±0.65% pre-operatively to 2.84±0.51% postoperatively (P=0.02) and mid expiratory forced expiratory flow (FEF25-75) was 1.81±0.48% pre-operatively, increasing to 1.91±0.50% postoperatively (P=0.02). Maximal expiratory flow at 25% of FVC (MEF25) increased from 1.09±0.36% pre-operatively to 1.21±0.34% postoperatively (P=0.02). There was no correlation among the other spirometric parameters (FEV1, FEV1/FVC, MEF50 and MEF75) pre- and post-operatively (P>0.05). Despite some improvements in pulmonary function indices, there was no correlation between changes in spirometric parameters and severity of the snoring (P>0.05). Although our findings reveal that adenotonsillectomy had a positive effect on pulmonary function tests, we found no significant correlation between alterations in spirometric parameters and severity of snoring. However, performing a spirometric examination in children with adenotonsillar hypertrophy may be beneficial for assessing the pulmonary status of the affected patient.

Upper airway obstruction.

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 …

Malignant extra renal rhabdoid tumour presenting as central airway obstruction.

Rhabdoid tumours are one of the most aggressive childhood neoplasms associated with high mortality. The commonest age group affected is children less than five years of age. Rhabdoid tumour presenting as an endoluminal tracheal mass leading to central airway obstruction has not been previously reported. We describe the case of a 17-year-old male patient where malignant rhabdoid tumour masqueraded as bronchial asthma leading to a delayed diagnosis of upper airway obstruction by tracheal growth. Histopathological examination and immunohistochemistry confirmed the diagnosis of malignant rhabdoid tumour.

Repeated Episodes of Respiratory Failure Due to Bilateral Vocal Cord Paralysis

BackgroundBilateral vocal cord paralysis can produce severe airway obstruction, leading to acute respiratory failure. Discriminating the pathology of the upper airway from chronic obstructive diseases of the lower airways often presents a challenge for clinicians in the Emergency Department. ObjectivesTo underlie the value of clinical examination and flow-volume loops in the establishment of diagnosis of upper airway obstruction. Case ReportWe describe the case of a 55-year-old female ex-smoker who presented with a long history of hoarseness and progressive exertional dyspnea. The patient developed repeated episodes of acute respiratory failure and was supported with noninvasive ventilation. The diagnosis of bilateral vocal cord paralysis was finally established by patient’s symptoms and flow-volume loops demonstrating variable extrathoracic obstruction. ConclusionVocal cord paralysis is a rare and often neglected condition, contributing to repeated episodes of acute respiratory failure. Flow-volume loop is a useful tool when symptoms are suggestive of upper airway obstruction.

An unusual cause of epistaxis, anemia and upper respiratory tract obstruction, Leeches: Report of three cases

The leech is an endoparasite for man and may cause lethal complications. In this article, we report two cases of 4 and 6-year-old who presented epistaxis due to leech infestasyon in nasopharynx and other case of 65-year-old adult with alzheimer who presented obstruction of upper respiratory tracks and anemia due to leech infestation in larynx. Especially in rural areas, it should always be borne in mind that leech might cause high mortality and morbidity due to serious complications such as anemia and obstruction of upper respiratory tracts and should be considered in evaluating the differential diagnosis of upper airway obstruction.

DISE: A 2‐Drug Comparison and Simultaneous Polysomnography

Objective: The aim of this study is to evaluate propofol and midazolam as sleep inducers in drug-induced sleep endoscopy, for the topographic diagnosis of upper airway obstruction during sleep; compare one to the other as well as with natural sleep polysomnography results. Method: Prospective series of 16 patients with suspected obstructive sleep apnea. Following physical examination and conventional polysomnography, sleep nasendoscopy along with simultaneous polysomnography was performed, obtaining apnea-hypopnea index, lowest oxygen saturation, apnea durations, and sleep cycle stages. The procedure was done with propofol and with midazolam. Results: There were 15 men and 1 woman; the mean age was 42.7 years old, mean body mass index 26.86. Average drug-induced sleep endoscopy (DISE) duration was 20 minutes with propofol and 14.3 minutes with midazolam. The induced-sleep stage obtained was of phase 2. On 12 of the patients a whole-night polysomnography study was performed and compared with sleep nasendoscopy results. Physical exam did not correlate with drug-induced sleep findings. There was a good correlation between DISE results with both drugs ( P &lt; .001). The average apnea-hypopnea index was 16.38 for natural sleep, 28.63 for propofol, and 38.11 for midazolam. Conclusion: Obstruction areas are equivalent no matter which of the 2 mentioned sedatives are used. Although DISE is not entirely equivalent to an entire night sleep it can be considered comparable to most of the night sleep events.

Drilling speaking valves to promote phonation in tracheostomy‐dependent children

Placement of a Passy-Muir speaking valve is considered best practice for infants and children with a tracheostomy. The Passy-Muir valve enables phonation by redirecting exhaled air via the glottis. Poor tolerance of the Passy-Muir valve is associated with excessive transtracheal pressures on exhalation due to upper airway obstruction. Drilling a small hole in the side of the Passy-Muir valve creates a pressure relief port to allow partial exhalation through the tracheostomy tube while enabling phonation. A retrospective case series is presented of 10 aphonic pediatric patients with a tracheostomy trialed with a drilled Passy-Muir valve. Valve tolerance was assessed clinically and objectively. Handheld manometry was used to determine transtracheal pressures on passive exhalation. All patients had a diagnosis of upper airway obstruction and demonstrated excessive pressures wearing a standard Passy-Muir valve. Patients were assessed wearing a Passy-Muir valve with up to two 1.6-mm holes drilled in the side of the valve. Patients progressed to trials if clinically stable and if transtracheal pressure did not exceed 10 cm H(2) O when wearing the valve. Eight patients progressed to trial, with five of eight patients able to phonate within 1 week and six of eight able to tolerate wearing the valve for ≥ 2-hour periods within 2 weeks of introduction. All eight patients were able to phonate within 6 months of valve introduction. These findings support drilling Passy-Muir speaking valves as a promising option to facilitate phonation in pediatric patients with a tracheostomy for upper airway obstruction.

Papillary thyroid carcinoma presenting with upper respiratory tract obstruction and pulmonary metastases

Thyroid cancer is rare in children especially before the age of 10 years. Upper airway obstruction and pulmonary infiltration are rare manifestations of such tumor. An 8-year-old school girl was admitted to Mansoura University Children's Hospital for a papillary thyroid carcinoma manifested by severe upper respiratory tract obstruction. CT scan of the chest revealed multiple miliary shadows in both lungs. Total thyroidectomy was performed and pathological examination confirmed the diagnosis of papillary carcinoma of the thyroid gland. The patient received ablative dose of Iodine 131 and replacement therapy of L-thyroxine. Thyroid cancer, although rare, should be considered for differential diagnosis of upper airway obstruction and pulmonary metastases.

Cuff-leak test for the diagnosis of upper airway obstruction in adults: a systematic review and meta-analysis

To evaluate, in adults, the diagnostic accuracy of the cuff-leak test for the diagnosis of upper airway obstruction secondary to laryngeal edema and for reintubation secondary to upper airway obstruction. Systematic review without language restrictions based on electronic databases and manual review of the literature up to December 2008. When appropriate, a random-effects meta-analysis and meta-regression (Moses' method) were performed. Upper airway obstruction was the outcome in nine studies with an overall incidence of 6.9%. There was significant heterogeneity among studies. The pooled sensitivity was 0.56 (95% confidence interval: 0.48-0.63), the specificity was 0.92 (95% CI: 0.90-0.93), the positive likelihood ratio was 5.90 (95% CI: 4.00-8.69), the negative likelihood ratio was 0.48 (95% CI: 0.33-0.72), and the diagnostic odds ratio was 18.78 (95% CI: 7.36-47.92). The area under the curve of the summary receiver-operator characteristic (SROC) was 0.92 (95% CI: 0.89-0.94). Only three studies have evaluated the accuracy of the cuff-leak test for reintubation secondary to upper airway obstruction. Overall incidence was 7%. The pooled sensitivity was 0.63 (95% CI: 0.38-0.84), the specificity was 0.86 (95% CI: 0.81-0.90), the positive likelihood ratio was 4.04 (95% CI: 2.21-7.40), the negative likelihood ratio was 0.46 (95% CI: 0.26-0.82), and the diagnostic odds ratio was 10.37 (95% CI: 3.70-29.13). A positive cuff-leak test (absence of leak) should alert the clinician of a high risk of upper airway obstruction.

Effect of tonsillectomy and/or adenoidectomy on pulmonary arterial pressure in adults

Abstract The aim of the study was to determine the mean pulmonary pressure in adult with hypertrophic tonsils and adenoids and to clarify whether tonsillectomy and adenoidectomy has any effect on mean pulmonary arterial pressure of these adult. The study was carried out on 50 patients with diagnosis of upper airway obstruction resulting from hypertrophied tonsils and adenoids (group1). 25 adults were assigned as control with similar age and sex distribution (group2). For study subjects Routine general Examinations, BMI, ECG, Chest X ray, Arterial blood gases and Echocardiography were done. Mean pulmonary arterial pressure was measured by using Doppler Echocardiography preoperatively and mean 3–4 months postoperatively in all subjects. Elevated PAP (pulmonary artery pressure) was found in 15 patients (30%) in group 1 preoperatively. Mean PAP was 28.34 ±5.11 mmHg preoperative in group 1 and 19.84 ± 5.0 mmHg in group 2 (p &lt;0.001). PAP decrease to 22.38 ±4.28 mmHg postoperatively in group 1 (p &lt;0.001). Arterial oxygen saturation (spo2%) increase from 93.5 ± 1.9% preoperatively to 95.3 ± 1.3% post operatively (p &lt; 0.001). percent reduction of PAP postoperatively correlates to age (t=−2.3, p= 0.02), preoperative PAP (p =0.01) but no correlation was found with BMI. In conclusions, this Study showed that obstructed adenoid and hypertrophy of tonsils causes higher mean pulmonary artery pressure in adult &amp; revealed that tonsil&amp; adenoid is effective therapeutic measure in such patients. With early intervention is necessary to avoid progressive cardiopulmonary disease.

The EXIT ( Ex Utero Intrapartum Treatment) Procedure

Fetuses with upper airway obstruction have a high mortality rate if proper airway management is not immediately administered after delivery. The EXIT (ex utero intrapartum treatment) procedure is a new technique that establishes the fetal airway while uteroplacental circulation is still maintained. The prognosis of such neonates has much improved after the introduction of this procedure. We report two neonates with prenatal diagnosis of upper airway obstruction; they were born smoothly via the EXIT procedure. The first was a case of epignathus, a rare type of nasopharyngeal or oropharyngeal teratoma derived from all three germ cell layers with variable maturity. The second was a case of giant lymphangioma that resulted from localized malformations in the development of the lymphatic system. Furthermore, compared with routine cesarean section, the short-term maternal outcomes were not different with regard to infection rate, estimated blood loss, wound complication, and postpartum hospital stay.

Inspiratory Flow Volume Loops and the Diagnosis of Upper Airway Obstruction

Inspiratory Flow Volume Loops and the Diagnosis of Upper Airway Obstruction

Effect of upper airway obstruction on pulmonary arterial pressure in children

Our aim was to examine the elevation of pulmonary arterial pressure in children with upper airway obstruction caused by adenotonsillar hypertrophy according to their disease severity assessed with symptom scoring and to demonstrate the profit for echocardiographic monitorization of the children with adenotonsillar hypertrophy regardless of their clinical status. Thirty-nine children with a diagnosis of upper airway obstruction caused by adenotonsillar hypertrophy were included for the study. There were 16 female and 23 male patients. Ages of the children were between 3 and 10 years with a mean age of 5.78+/-1.98. Twenty children composed the control group with a similar age and sex distribution but without any sign and symptom of upper airway obstruction. Mean pulmonary arterial pressures were measured by Doppler echocardiography preoperatively and 6 months postoperatively. Symptom scores were calculated for each patient in the study group to assess their disease severity. The significances of changes and relations between pressure levels and symptom scores were calculated by statistical package for social sciences (SSPS) computer program in terms of Student's test, chi(2)-test and Mc Nemar's test. Mean pulmonary arterial pressure were 26.26+/-5.40 (14-36) preoperatively, 16,61+/-2.68 (10.15-22.3) postoperatively and 16.54+/-2.63 (10.5-21.7) in the control group. There were a statistically significant decrease at pressure levels postoperatively and a significant difference from the levels in the control group (Student's t-test, p<0.01). We found no correlation between the pressure levels and disease severity assessed in terms of symptom scoring. This study showed that upper airway obstruction caused by adenotonsillar hypertrophy causes significant elevation of pulmonary arterial pressures and adenotonsilectomy is an absolute therapeutic method in these children. Every child with adenotonsillar hypertrophy has some probability of having pulmonary hypertension regardless of his or her disease severity. Therefore, performing echocardiographic examination to all children with adenotonsillar hypertrophy is beneficial for assessing the cardiopulmonary status of the patient and may be useful at decision making for adenotonsilectomy.

Laryngeal involvement in a patient with bullous pemphigoid

Laryngeal involvement in a patient with bullous pemphigoid