Upper Airway Obstruction(Archived)

The upper airway comprises the nasal cavities, oral cavity, pharynx, and larynx. The pharynx is further subdivided into the nasopharynx, oropharynx, and hypopharynx. The larynx is divided into 3 regions, dependent on their relationship to the vocal cords (glottis). These areas are the supraglottis, glottis, and subglottis. The supraglottis consists of the epiglottis, the arytenoids, the aryepiglottic folds, the false cords, and the ventricles. The subglottis is the subregion below the vocal cords' free edge to the cricoid's inferior margin. The narrowest part of an adult airway is the glottis. The narrowest part of a pediatric airway is the cricoid. Upper airway obstruction varies from narrowing to partial or complete occlusion of these anatomic structures, potentially leading to a compromise in ventilation. Given the urgency related to this issue, it is crucial that healthcare professionals fully understand and appreciate the signs and symptoms that indicate upper airway obstruction. When forming a differential diagnosis for upper airway obstruction, it is important to determine the level at which the obstruction is occurring. A vital clinical sign is noisy breathing, described as "stertor" or "stridor." Stertor is noisy breathing, which occurs above the larynx. Stridor is noisy breathing that occurs at the level of the larynx or below. Stridor can be further subdivided into inspiratory (level of the supraglottis), expiratory (level of the glottis), and biphasic (level of the subglottis or trachea). Upper airway obstruction can be partial or complete. A partial obstruction can be chronic or acute. Therefore, it is crucial to take a good history and perform an efficient and comprehensive exam to determine the etiology of the obstruction and the urgency of subsequent management. Left untreated, upper airway obstruction can have significant long-term or fatal effects.