Journal articles: 'Upper airways obstruction'

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Lloyd, E. L. "Upper airways obstruction." British Journal of Sports Medicine 34, no. 1 (February 1, 2000): 69–70. http://dx.doi.org/10.1136/bjsm.34.1.69.

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Doumit, J., P. Belvitch, and I. Rubinstein. "ID: 127: DECREASED CPAP ADHERENCE IN NON-OBESE OSA PATIENTS WITH REVERSIBLE UPPER AIRWAY OBSTRUCTION." Journal of Investigative Medicine 64, no. 4 (March 22, 2016): 970.1–970. http://dx.doi.org/10.1136/jim-2016-000120.123.

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RationaleUpper airway resistance is critical to the pathophysiology of obstructive sleep apnea (OSA). We have previously characterized a subset of patients with OSA who have evidence of reversible upper airways resistance as measured by spirometry. Specifically, these patients have an increased FEF50/FIF50 ratio which decreases with administration of a short acting bronchodilator. On average these patients had a lower BMI (average 27) compared to OSA patients as a whole suggesting the possibility of unique upper airway pathophysiology among this group. In the current study, we identify additional patients with OSA who have reversible upper airways obstruction on spirometry and characterize their compliance with CPAP therapy as compared to a traditional OSA population.MethodsWe retrospectively evaluated patients who had a sleep screen suggestive of OSA in the last 2 years. Patients who also had spirometry in the previous 5 years were identified for further analysis. Those patients with either normal spirometry or fixed obstructive defects who had a decrease in the FEF50/FIF50 ratio after administration of a short acting inhaled beta agonist (albuterol) were then characterized. We then measured objective CPAP adherence using data downloaded from the positive airway pressure device with adherence defined as CPAP use >4 hrs more than 70% of nights over a 30 day period.ResultsWe identified 70 patients with positive sleep screens who also had spirometry demonstrating normal of fixed lower expiratory obstruction with evidence of upper airways obstruction as demonstrated by a decreased FEF50/FIF50 ratio. Of these, 45 had a decrease in the FEF50/FIF50 ratio of more than 20% following administration of inhaled albuterol. Overall, CPAP adherence between those with reversible upper airways obstruction and those without was similar (23/45=51% vs 14/26=54%). However, subgroup analysis revealed a lower adherence rate among non-obese patients (BMI<30) with reversible airways obstruction (6/16=36%).ConclusionThe identification of a subset of patients with OSA who have evidence of decreased upper airway resistance in response to inhaled bronchodilator suggests unique pathology in this group. Decreased adherence to traditional OSA therapy with CPAP among these patients is additional evidence of differential pathophysiology requiring novel treatments. Specifically, treatment with a long acting beta agonist (LABA) prior to sleep may reduce upper airway obstruction and be better tolerated than CPAP.

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Stephenson, John. "Imposed upper airways obstruction." Journal of Pediatric Neurology 08, no. 01 (July 30, 2015): 043–45. http://dx.doi.org/10.3233/jpn-2010-0342.

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Enoz, Murat. "Effects of Nasal Pathologies on Obstructive Sleep Apnea." Acta Medica (Hradec Kralove, Czech Republic) 50, no. 3 (2007): 167–70. http://dx.doi.org/10.14712/18059694.2017.77.

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Increased airway resistance can induce snoring and sleep apnea, and nasal obstruction is a common problem in snoring and obstructive sleep apnea (OSA) patients. Many snoring and OSA patients breathe via the mouth during sleep. Mouth breathing may contribute to increased collapsibility of the upper airways due to decreased contractile efficiency of the upper airway muscles as a result of mouth opening. Increased nasal airway resistance produces turbulent flow in the nasal cavity, induces oral breathing, promotes oscillation of the pharyngeal airway and can cause snoring.

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Alloubi, Ihsan, Matthieu Thumerel, Hugues Bégueret, Jean-Marc Baste, Jean-François Velly, and Jacques Jougon. "Outcomes after Bronchoscopic Procedures for Primary Tracheobronchial Amyloidosis: Retrospective Study of 6 Cases." Pulmonary Medicine 2012 (2012): 1–4. http://dx.doi.org/10.1155/2012/352719.

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Respiratory amyloidosis is a rare disease which refers to localized aberrant extracellular protein deposits within the airways. Tracheobronchial amyloidosis (TBA) refers to the deposition of localized amyloid deposits within the upper airways. Treatments have historically focused on bronchoscopic techniques including debridement, laser ablation, balloon dilation, and stent placement. We present the outcomes after rigid bronchoscopy to remove the amyloid protein causing the airway obstruction in 6 cases of tracheobronchial amyloidosis. This is the first report of primary diffuse tracheobronchial amyloidosis in our department; clinical features, in addition to therapy in the treatment of TBA, are reviewed. This paper shows that, in patients with TBA causing airway obstruction, excellent results can be obtained with rigid bronchoscopy and stenting of the obstructing lesion.

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Na, Ji Sung, Hwi-Dong Jung, Hyung-Ju Cho, Yoon Jeong Choi, and Joon Sang Lee. "Computational analysis of airflow dynamics for predicting collapsible sites in the upper airways: a preliminary study." Journal of Applied Physiology 126, no. 2 (February 1, 2019): 330–40. http://dx.doi.org/10.1152/japplphysiol.00522.2018.

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The present study aimed to detail the relationship between the flow and structure characteristics of the upper airways and airway collapsibility in obstructive sleep apnea. Using a computational approach, we performed simulations of the flow and structure of the upper airways in two patients having different facial morphologies: retruding and protruding jaws, respectively. First, transient flow simulation was performed using a prescribed volume flow rate to observe flow characteristics within upper airways with an unsteady effect. In the retruding jaw, the maximum magnitude of velocity and pressure drop with velocity shear and vortical motion was observed at the oropharyngeal level. In contrast, in the protruding jaw, the overall magnitude of velocity and pressure was relatively small. To identify the cause of the pressure drop in the retruding jaw, pressure gradient components induced by flow were examined. Of note, vortical motion was highly associated with pressure drop. Structure simulation was performed to observe the deformation and collapsibility of soft tissue around the upper airways using the surface pressure obtained from the flow simulation. At peak flow rate, the soft tissue of the retruding jaw was highly expanded, and a collapse was observed at the oropharyngeal and epiglottis levels. NEW & NOTEWORTHY Aerodynamic characteristics have been reported to correlate with airway occlusion. However, a detailed mechanism of the phenomenon within the upper airways and its impact on airway collapsibility remain poorly understood. This study provides in silico results for aerodynamic characteristics, such as vortical structure, pressure drop, and exact location of the obstruction using a computational approach. Large deformation of soft tissue was observed in the retruding jaw, suggesting that it is responsible for obstructive sleep apnea.

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Kathuria, Sunil, and Chikku Sunny. "Unusual presentation of ectopic thyroid causing respiratory distress." International Journal of Otorhinolaryngology and Head and Neck Surgery 6, no. 6 (May 22, 2020): 1188. http://dx.doi.org/10.18203/issn.2454-5929.ijohns20202087.

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<p>Internal obstruction of the upper airways can be due to infection, anaphylactic reaction, congenital anomaly, foreign body inhalation or mass. The endoluminal presence of thyroid tissue in the trachea is a rare cause of airway obstruction. Only 14 well documented cases of intratracheal ectopic thyroid tissue have been reported in English literature since 1966. These lesions are mostly benign and nearly all patient present with symptoms of respiratory obstruction. This case report is of a lady who presented with upper airway obstruction due to subglottic ectopic thyroid tissue. An ectopic thyroid gland can develop if its normal migration is halted along this tract during embryogenesis. Subglottic location of ectopic thyroid is extremely rare. However, ectopic thyroid tissue in the larynx should be considered as a possible diagnosis causing upper airway obstruction.</p>

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Watters, M. P. R., and J. M. Mckenzie. "Inhalational Induction with Sevoflurane in an Adult with Severe Complex Central Airways Obstruction." Anaesthesia and Intensive Care 25, no. 6 (December 1997): 704–6. http://dx.doi.org/10.1177/0310057x9702500621.

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Sevoflurane is a newly available volatile anaesthetic agent which is suitable for inhalational induction of anaesthesia. Due to concerns about obstructing the upper airway as anaesthesia deepens, its use has until now been avoided in patients with upper airway obstruction. We used its smooth induction and recovery properties however to anaesthetize a patient with central airway obstruction and coexistent ischaemic heart disease. Sevoflurane proved to be a very satisfactory agent in this situation.

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Demajumdar, R., and P. B. Rajesh. "Have we got the full picture?" Journal of Laryngology & Otology 112, no. 8 (August 1998): 788–89. http://dx.doi.org/10.1017/s0022215100141714.

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AbstractA 59-year-old man with long-standing chronic obstructive airways disease (COPD), became progressively dyspnoeic, and repeatedly blacked-out during forced expiration. Spirometry suggested the possibility of large airways obstruction, and failing to respond to aggressive bronchodilator and steroid therapy, the patient was labelled as being non-compliant. Finally, he was assessed by an otolaryngologist and a cause for upper airway obstruction was suspected. Bronchoscopy and computed tomography (CT) scanning demonstrated tracheomalacia and the patient underwent resection of this segment of abnormal trachea.Tracheomalacia, although rare, results from the substitution of cartilage with fibrous tissue, leading to severe airway compromise.This case emphasizes the fact that although many conditions are uncommon, the total incidence of rare conditions is surprisingly high, and that care needs to be taken at all times in the management of ‘labelled’ patients with chronic illness, in order not to overlook such life-threatening diagnoses.

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Camacho, Macario, Justin M. Wei, Lauren K. Reckley, and Sungjin A. Song. "Double Barrel Nasal Trumpets to Prevent Upper Airway Obstruction after Nasal and Non-Nasal Surgery." Anesthesiology Research and Practice 2018 (2018): 1–6. http://dx.doi.org/10.1155/2018/8567516.

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Objectives. During anesthesia emergence, patients are extubated and the upper airway can become vulnerable to obstruction. Nasal trumpets can help prevent obstruction. However, we have found no manuscript describing how to place nasal trumpets after nasal surgery (septoplasties or septorhinoplasties), likely because (1) the lack of space with nasal splints in place and (2) surgeons may fear that removing the trumpets could displace the splints. The objective of this manuscript is to describe how to place nasal trumpets even with nasal splints in place. Materials and Methods. The authors describe techniques (Double Barrel Technique and Modified Double Barrel Technique) that were developed over three years ago and have been used in patients with obstructive sleep apnea (OSA) and other patients who had collapsible or narrow upper airways (i.e., morbidly obese patients). Results. The technique described in the manuscript provides a method for placing one long and one short nasal trumpet in a manner that helps prevent postoperative upper airway obstruction. The modified version describes a method for placing nasal trumpets even when there are nasal splints in place. Over one-hundred patients have had nasal trumpets placed without postoperative oxygen desaturations. Conclusions. The Double Barrel Technique allows for a safe emergence from anesthesia in patients predisposed to upper airway obstruction (such as in obstructive sleep apnea and morbidly obese patients). To our knowledge, the Modified Double Barrel Technique is the first description for the use of nasal trumpets in patients who had nasal surgery and who have nasal splints in place.

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Aldridge, L. M. "An unusual cause of upper airways obstruction." Anaesthesia 42, no. 11 (November 1987): 1239–40. http://dx.doi.org/10.1111/j.1365-2044.1987.tb05258.x.

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Price, M. "An unusual case of upper airways obstruction." Anaesthesia 43, no. 3 (February 22, 2007): 257. http://dx.doi.org/10.1111/j.1365-2044.1988.tb05583.x.

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Niven, R. McL, T. Roberts, C. A. C. Pickering, and A. K. Webb. "Functional upper airways obstruction presenting as asthma." Respiratory Medicine 86, no. 6 (November 1992): 513–16. http://dx.doi.org/10.1016/s0954-6111(96)80013-8.

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Murrant, N. J., and D. J. Gatland. "Respiratory problems in acromegaly." Journal of Laryngology & Otology 104, no. 1 (January 1990): 52–55. http://dx.doi.org/10.1017/s0022215100111806.

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AbstractDeath from respiratory causes in acromegaly is three times more common than in the general population and is most often the result of upper airways obstruction, although less commonly pulmonary dysfunction and disturbance of the central nervous system may occur. These factors may be found alone or in combination.Despite several reports of laryngeal involvement, upper airway obstruction in acromegaly is usually regarded as being due to macroglossia and pharyngeal soft tissue hypertrophy. We present four cases of acromegaly in which tracheostomy was required for laryngeal obstruction, with a review of the literature concerning the nature of respiratory problems in acromegaly.

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Molnár, Viktória, Zoltán Lakner, András Molnár, Dávid László Tárnoki, Ádám Domonkos Tárnoki, László Kunos, Zsófia Jokkel, and László Tamás. "The Predictive Role of the Upper-Airway Adipose Tissue in the Pathogenesis of Obstructive Sleep Apnoea." Life 12, no. 10 (October 4, 2022): 1543. http://dx.doi.org/10.3390/life12101543.

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This study aimed to analyse the thickness of the adipose tissue (AT) around the upper airways with anthropometric parameters in the prediction and pathogenesis of OSA and obstruction of the upper airways using artificial intelligence. One hundred patients were enrolled in this prospective investigation, who were divided into control (non-OSA) and mild, moderately severe, and severe OSA according to polysomnography. All participants underwent drug-induced sleep endoscopy, anthropometric measurements, and neck MRI. The statistical analyses were based on artificial intelligence. The midsagittal SAT, the parapharyngeal fat, and the midsagittal tongue fat were significantly correlated with BMI; however, no correlation with AHI was observed. Upper-airway obstruction was correctly categorised in 80% in the case of the soft palate, including parapharyngeal AT, sex, and neck circumference parameters. Oropharyngeal obstruction was correctly predicted in 77% using BMI, parapharyngeal AT, and abdominal circumferences, while tongue-based obstruction was correctly predicted in 79% using BMI. OSA could be predicted with 99% precision using anthropometric parameters and AT values from the MRI. Age, neck circumference, midsagittal and parapharyngeal tongue fat values, and BMI were the most vital parameters in the prediction. Basic anthropometric parameters and AT values based on MRI are helpful in predicting OSA and obstruction location using artificial intelligence.

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Misiolek, M., D. Ziora, K. Oklek, and G. Namyslowski. "Evaluation of upper airway obstruction after partial laryngectomies by radiological method and flow–volume loop analysis." Journal of Laryngology & Otology 108, no. 11 (November 1994): 954–56. http://dx.doi.org/10.1017/s0022215100128610.

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AbstractAnatomical and functional estimations of the upper airways in patients after partial laryngectomies (cordectomy, hemilaryngectomy, enlarged hemilaryngectomy) carried out due to cancer are discussed in this paper. The post-operative lumen of the larynx and the trachea were estimated by radiological examination. The coefficient larynx/trachea (L/T) was proposed to describe fixed obstruction.At the same time, all patients underwent spirometric examinations. Inspiratory and expiratory parameters of the flow-volume loop were evaluated. In 39 patients the L/T coefficient was lower than in a group of patients with chronic bronchitis (P<0.05). Also inspiratory and some expiratory parameters of the flow–volume loop decreased in contrast to the group with chronic bronchitis. All results showed the usefulness of radiological and spirometric methods in detecting upper airway obstructions and confirmed their fixed character. The influence of the area of operation on the degree of upper airway obstruction was emphasized.

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de Moreno, Lauren C. Anderson, Bruce H. Matt, Gregory Montgomery, and Young-Jee Kim. "Propranolol in the Treatment of Upper Airway Hemangiomas." Ear, Nose & Throat Journal 92, no. 5 (May 2013): 209–14. http://dx.doi.org/10.1177/014556131309200514.

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Airway hemangiomas (AHs), which are common in infant airways, often cause significant upper airway obstruction. The various therapies used for AH have limitations and complications. Propranolol may have a potential role in its treatment, since it leads to regression or stabilization of cutaneous infantile hemangiomas. To date, only 4 previous case reports (7 patients) in which propranolol was used for AH have been published. Based on encouraging preliminary data on propranolol use for AH treatment, our goal was to further investigate propranolol as an effective initial treatment of upper AHs that cause significant obstruction symptoms. In this retrospective case series, we reviewed the medical records of 5 consecutive pediatric patients with AH (glottic and subglottic) treated with propranolol at a tertiary care children's hospital. All 5 patients were 2 months of age at the time of hemangioma diagnosis and had stridor and physical signs of severe upper airway obstruction. Hemangioma was diagnosed by flexible laryngoscopy or flexible bronchoscopy. All patients received propranolol 2 mg/kg/day and showed significant relief of obstruction symptoms within 24 hours of treatment initiation. All patients tolerated propranolol without significant cardiovascular complications. Outcomes from this case series, in conjunction with available case reports in the literature, suggest that propranolol is a safe initial treatment for symptomatic upper AH.

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Iannella, Giannicola, Giovanni Cammaroto, Giuseppe Meccariello, Angelo Cannavicci, Riccardo Gobbi, Jerome Rene Lechien, Christian Calvo-Henríquez, et al. "Head-Of-Bed Elevation (HOBE) for Improving Positional Obstructive Sleep Apnea (POSA): An Experimental Study." Journal of Clinical Medicine 11, no. 19 (September 23, 2022): 5620. http://dx.doi.org/10.3390/jcm11195620.

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Purpose: Evaluate the effectiveness of the head-of-bed elevation position (HOBE) with a 30° elevation of the head and trunk, in improving obstruction of the upper airways in obstructive sleep apnea (OSA) patients. A prospective trial simultaneously performing drug-induced sleep endoscopy (DISE) and polysomnography (PSG) tests was performed. Methods: Forty-five patients were included in the prospective study protocol. All patients enrolled in the study and underwent the following evaluations: (1) a drug-induced sleep endoscopy, with an evaluation of obstructions and collapse of the upper airways at 0° and in a HOBE position, with head and trunk elevation of 30°; (2) an overnight PSG assessment in the hospital with head and trunk elevation from 0° to 30° during the night; (3) a questionnaire to evaluate the feedback of patients to sleeping with head-of-bed elevation. Results: Velum (V) and oropharynx lateral wall (O) collapses were reduced in the 30° up position. There were no statistical differences that emerged in the obstruction of the tongue base and epiglottis between the 0° position and the 30° up position (p > 0.05). The average AHI score changed from 23.8 ± 13.3 (0° supine position) to 17.7 ± 12.4 (HOBE position), with a statistical difference (p = 0.03); the same statistical difference emerged in the percentage of apneas that decreased from 55 ± 28.1 to 44 ± 25.8 (p = 0.05). Conclusions: By adopting the HOBE position with 30° elevation of the head and trunk, it is possible to obtain a reduction of upper airways collapses and an improvement of apnea/hypopnea events and nightly respiratory outcomes.

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Artunc Ulkumen, Burcu, Halil Gursoy Pala, Nalan Nese, Serdar Tarhan, and Yesim Baytur. "Prenatal Diagnosis of Congenital High Airway Obstruction Syndrome: Report of Two Cases and Brief Review of the Literature." Case Reports in Obstetrics and Gynecology 2013 (2013): 1–4. http://dx.doi.org/10.1155/2013/728974.

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Congenital high airway obstruction syndrome (CHAOS) is the obstruction of the fetal upper airways, which may be partial or complete. It is usually incompatible with life. Prenatal recognition of the disease is quite important due to the recently described management options. We report here two cases of CHAOS due to tracheal atresia diagnosed by antenatal ultrasonography and fetal MRI. We also briefly review the relevant literature with the associated management options.

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De Vito, Andrea, B. Tucker Woodson, Venkata Koka, Giovanni Cammaroto, Giannicola Iannella, Marcello Bosi, Stefano Pelucchi, Giulio Romano Filograna-Pignatelli, Pierre El Chater, and Claudio Vicini. "OSA Upper Airways Surgery: A Targeted Approach." Medicina 57, no. 7 (July 6, 2021): 690. http://dx.doi.org/10.3390/medicina57070690.

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Obstructive sleep apnea syndrome (OSA) is a multi-factorial disorder, with quite complex endotypes, consisting of anatomical and non-anatomical pathophysiological factors. Continuous positive airway pressure (CPAP) is recognized as the first-line standard treatment for OSA, whereas upper airway (UA) surgery is often recommended for treating OSA patients who have refused or cannot tolerate CPAP. The main results achievable by the surgery are UA expansion, and/or stabilization, and/or removal of the obstructive tissue to different UA levels. The site and pattern of UA collapse identification is of upmost importance in selecting the customized surgical procedure to perform, as well as the identification of the relation between anatomical and non-anatomical factors in each patient. Medical history, sleep studies, clinical examination, UA endoscopy in awake and drug-induced sedation, and imaging help the otorhinolaryngologist in selecting the surgical candidate, identifying OSA patients with mild UA collapsibility or tissue UA obstruction, which allow achievement of the best surgical outcomes. Literature data reported that the latest palatal surgical procedures, such as expansion sphincter palatoplasty or barbed reposition palatoplasty, which achieve soft palatal and lateral pharyngeal wall remodeling and stiffening, improved the Apnea Hypopnea Index, but the outcome analyses are still limited by methodological bias and the limited number of patients’ in each study. Otherwise, the latest literature data have also demonstrated the role of UA surgery in the improvement of non-anatomical factors, confirming that a multidisciplinary and multimodality diagnostic and therapeutical approach to OSA patients could allow the best selection of customized treatment options and outcomes.

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Maria Amadei, Enrico, Laura Benedettini, and Marco Trebbi. "Infectious Mononucleosis with Upper Airway Obstruction: when tracheotomy and tonsillectomy can be helpful." Journal of Clinical Otorhinolaryngology 3, no. 2 (July 2, 2021): 01–04. http://dx.doi.org/10.31579/2692-9562/028.

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Infectious mononucleosis is caused by Epstein-Barr virus, which infects more than 98% of the world's adult population. Approximately 90% of adults become antibody-positive before the age of 30. The ages of 15-24 years are the most likely time for the onset of symptoms. We report the case of a 13-year-old girl who came to our emergency department for bilateral erythematous-poltaceous tonsillitis complicated by dysphagia and dyspnea. She had a diagnosis of infectious mononucleosis. For some hours the young woman presented an inconsistency between a marked respiratory distress and the patency of her upper airways. Finally the clinical picture fell suddenly, requiring an emergency tracheotomy to ensure a patent airway. In the following days a diagnosis of a left parapharyngeal abscess was reached. A tonsillectomy with drainage of the parapharyngeal abscess was required. It is well known that infectious mononucleosis is typically a silent infection. We describe the case of a girl who risked losing her life due to aggressive infectious mononucleosis, and how we treated her. Such a complicated case has never been described in Literature.

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Onal, E., D. L. Burrows, R. H. Hart, and M. Lopata. "Induction of periodic breathing during sleep causes upper airway obstruction in humans." Journal of Applied Physiology 61, no. 4 (October 1, 1986): 1438–43. http://dx.doi.org/10.1152/jappl.1986.61.4.1438.

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To test the hypothesis that occlusive apneas result from sleep-induced periodic breathing in association with some degree of upper airway compromise, periodic breathing was induced during non-rapid-eye-movement (NREM) sleep by administering hypoxic gas mixtures with and without applied external inspiratory resistance (9 cmH2O X l-1 X s) in five normal male volunteers. In addition to standard polysomnography for sleep staging and respiratory pattern monitoring, esophageal pressure, tidal volume (VT), and airflow were measured via an esophageal catheter and pneumotachograph, respectively, with the latter attached to a tight-fitting face mask, allowing calculation of total pulmonary system resistance (Rp). During stage I/II NREM sleep minimal period breathing was evident in two of the subjects; however, in four subjects during hypoxia and/or relief from hypoxia, with and without added resistance, pronounced periodic breathing developed with waxing and waning of VT, sometimes with apneic phases. Resistive loading without hypoxia did not cause periodicity. At the nadir of periodic changes in VT, Rp was usually at its highest and there was a significant linear relationship between Rp and 1/VT, indicating the development of obstructive hypopneas. In one subject without added resistance and in the same subject and in another during resistive loading, upper airway obstruction at the nadir of the periodic fluctuations in VT was observed. We conclude that periodic breathing resulting in periodic diminution of upper airway muscle activity is associated with increased upper airway resistance that predisposes upper airways to collapse.

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Warburton, C. J., R. McL Niven, B. G. Higgins, and C. A. Pickering. "Functional upper airways obstruction: two patients with persistent symptoms." Thorax 51, no. 9 (September 1, 1996): 965–66. http://dx.doi.org/10.1136/thx.51.9.965.

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Smith, O. P., H. G. Prentice, G. M. Madden, and B. Nazareth. "Lingual cellulitis causing upper airways obstruction in neutropenic patients." BMJ 300, no. 6716 (January 6, 1990): 24. http://dx.doi.org/10.1136/bmj.300.6716.24.

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&NA;. "Upper and Lower Airways Obstruction Following an Inhalation Injury." Journal of Occupational and Environmental Medicine 55, no. 5 (May 2013): 594–96. http://dx.doi.org/10.1097/jom.0b013e318229a68f.

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Jimah, Bashiru B., Teresa A. Mensah, Kofi Ulzen-Appiah, Benjamin D. Sarkodie, Edwin Gwira-Tamattey, and Dorothea A. Anim. "Congenital high airway obstruction syndrome: prenatal ultrasound diagnosis and literature review." Second Edition in 2020 of the HSI Journal Volume 1 Issue 2 Publication 1, no. 2 (December 22, 2020): 144–48. http://dx.doi.org/10.46829/hsijournal.2020.12.1.2.144-148.

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Congenital high airway obstruction syndrome (CHAOS) is a rare congenital anomaly involving the upper airways (trachea, larynx). It is a life-threatening condition whose true incidence is unknown. The obstruction may be due to tracheal/laryngeal atresia, stenosis, or the presence of a mass lesion. Prognosis is poor, generally resulting in stillbirth or intrauterine fetal demise. Ex utero intrapartum treatment (EXIT) is possible if the condition is detected early. We present a case of CHAOS diagnosed during a second-trimester anomaly scan with postmortem confirmation and literature review.

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Jimah, Bashiru B., Teresa A. Mensah, Kofi Ulzen-Appiah, Benjamin D. Sarkodie, Edwin Gwira-Tamattey, and Dorothea A. Anim. "Congenital high airway obstruction syndrome: prenatal ultrasound diagnosis and literature review." Second Edition in 2020 of the HSI Journal Volume 1 Issue 2 Publication 1, no. 2 (December 22, 2020): 144–48. http://dx.doi.org/10.46829/hsijournal.2020.12.1.2.144-148.

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Congenital high airway obstruction syndrome (CHAOS) is a rare congenital anomaly involving the upper airways (trachea, larynx). It is a life-threatening condition whose true incidence is unknown. The obstruction may be due to tracheal/laryngeal atresia, stenosis, or the presence of a mass lesion. Prognosis is poor, generally resulting in stillbirth or intrauterine fetal demise. Ex utero intrapartum treatment (EXIT) is possible if the condition is detected early. We present a case of CHAOS diagnosed during a second-trimester anomaly scan with postmortem confirmation and literature review.

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Di Vece, Luca, Tiziana Doldo, Giacomo Faleri, Maria Picciotti, Lorenzo Salerni, Alessandro Ugolini, and Cecilia Goracci. "Rhinofibroscopic and Rhinomanometric Evaluation of Patients with Maxillary Contraction Treated with Rapid Maxillary Expansion. A Prospective Pilot Study." Journal of Clinical Pediatric Dentistry 42, no. 1 (January 1, 2018): 27–31. http://dx.doi.org/10.17796/1053-4628-42.1.5.

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Objective: The aim of this study was to evaluate through nasal fiber optic endoscopy and rhinomanometry the patency of upper nasal airways in patients treated with rapid palatal expansion Study design: 30 patients (12 males and 18 females) aged 7–11 years with transverse maxillary constriction underwent rhinomanometric and fiberoptic examination before (T0) and after rapid palatal expansion (T1).The amount of nasopharynx obstruction was quantified with reference to the full choanal surface. Nasal resistance was recorded separately for right and left sides, and combined for both sides. The differences in nasopharynx obstruction and in nasal resistance between T0 and T1 were statistically evaluated. Results: The amount of nasopharynx obstruction significantly decreased after palatal expansion (p<0.001). Total nasal inspiration and expiration resistance significantly decreased at T1 (p<0.001). The reduction ranged between 0. 23 and 0. 66 Pa/cm3/s for inspiration and between 0. 20 and 0,.58 Pa/cm3/s for expiration. A statistically significant positive correlation existed between the T1-T0 differences in the amount of nasopharynx obstruction and the T1-T0 differences in expiration nasal airway resistance (Spearman's correlation coefficient rho = 0.38; p = 0.03). Conclusions: Rapid maxillary expansion has an influence on nasal resistance and improves the patency of upper airways in patients with minor or moderate breathing problems.

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Bertholdt, Charline, Estelle Perdriolle-Galet, Pascale Bach-Segura, and Olivier Morel. "Tracheal Agenesis: A Challenging Prenatal Diagnosis—Contribution of Fetal MRI." Case Reports in Obstetrics and Gynecology 2015 (2015): 1–3. http://dx.doi.org/10.1155/2015/456028.

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Tracheal agenesis is a rare congenital anomaly. The prevalence is less than 1 : 50 000 with a male to female ratio of 2 : 1. This anomaly may be isolated but, in 93% of cases, it is part of polymalformative syndrome. The most evocative diagnosis situation is the ultrasonographic congenital high airway obstruction syndrome. Dilated airways, enlarged lungs with flattened diaphragm, fetal ascites and severe nonimmune hydrops can be observed. In the absence of a congenital high airway obstruction syndrome, the antenatal diagnosis of tracheal agenesis is difficult. Tracheal agenesis should be suspected in the presence of an unexplained polyhydramnios associated with congenital malformations. The fetal airway exploration should then be systematically performed by fetal thoracic magnetic resonance imaging. A case of Floyd’s type II tracheal agenesis, detected during the postnatal period, is reported here. The retrospective reexamination of fetal magnetic resonance images showed that the antenatal diagnosis would have been easy if a systematical examination of upper airways had been performed. Prenatal diagnosis of tracheal agenesis is possible with fetal MRI but the really challenge is to think about this pathology.

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Hybášková, Jaroslava, Ondřej Jor, Vilém Novák, Karol Zeleník, Petr Matoušek, and Pavel Komínek. "Drug-Induced Sleep Endoscopy Changes the Treatment Concept in Patients with Obstructive Sleep Apnoea." BioMed Research International 2016 (2016): 1–5. http://dx.doi.org/10.1155/2016/6583216.

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The present study evaluated whether drug-induced sleep endoscopy (DISE) helps identify the site of obstruction in patients with obstructive sleep apnoea (OSA). A total of 51 consecutive patients with polysomnography-confirmed OSA were enrolled in this prospective study. The presumed site of obstruction was determined according to history, otorhinolaryngologic examination, and polysomnography and a therapeutic plan designed before DISE. In 11 patients with severe OSA and/or previously failed continuous positive airway pressure (CPAP) treatment, DISE with simultaneous CPAP was performed. Multilevel collapse was noted in 49 patients (96.1%). The most frequent multilevel collapse was palatal, oropharyngeal, and tongue base collapse (n=17, 33.3%), followed by palatal and oropharyngeal collapse (n=12, 23.5%). Pathology of the larynx (epiglottis) was observed in 16 patients (31.4%). The laryngeal obstruction as a reason for intolerance of CPAP was observed in 3/11 (27.3%) patients. After DISE, the surgical plan was changed in 31 patients (60.8%). The results indicate that DISE helps identify the site of obstruction in the upper airways in patients with OSA more accurately and that the larynx plays an important role in OSA.

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Biselli, Paolo, Peter R. Grossman, Jason P. Kirkness, Susheel P. Patil, Philip L. Smith, Alan R. Schwartz, and Hartmut Schneider. "The effect of increased lung volume in chronic obstructive pulmonary disease on upper airway obstruction during sleep." Journal of Applied Physiology 119, no. 3 (August 1, 2015): 266–71. http://dx.doi.org/10.1152/japplphysiol.00455.2014.

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Patients with chronic obstructive pulmonary disease (COPD) exhibit increases in lung volume due to expiratory airflow limitation. Increases in lung volumes may affect upper airway patency and compensatory responses to inspiratory flow limitation (IFL) during sleep. We hypothesized that COPD patients have less collapsible airways inversely proportional to their lung volumes, and that the presence of expiratory airflow limitation limits duty cycle responses to defend ventilation in the presence of IFL. We enrolled 18 COPD patients and 18 controls, matched by age, body mass index, sex, and obstructive sleep apnea disease severity. Sleep studies, including quantitative assessment of airflow at various nasal pressure levels, were conducted to determine upper airway mechanical properties [passive critical closing pressure (Pcrit)] and for quantifying respiratory timing responses to experimentally induced IFL. COPD patients had lower passive Pcrit than their matched controls (COPD: −2.8 ± 0.9 cmH2O; controls: −0.5 ± 0.5 cmH2O, P = 0.03), and there was an inverse relationship of subject's functional residual capacity and passive Pcrit (−1.7 cmH2O/l increase in functional residual capacity, r2 = 0.27, P = 0.002). In response to IFL, inspiratory duty cycle increased more ( P = 0.03) in COPD patients (0.40 to 0.54) than in controls (0.41 to 0.51) and led to a marked reduction in expiratory time from 2.5 to 1.5 s ( P < 0.01). COPD patients have a less collapsible airway and a greater, not reduced, compensatory timing response during upper airway obstruction. While these timing responses may reduce hypoventilation, it may also increase the risk for developing dynamic hyperinflation due to a marked reduction in expiratory time.

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Maniaci, Antonino, Giannicola Iannella, Salvatore Cocuzza, Claudio Vicini, Giuseppe Magliulo, Salvatore Ferlito, Giovanni Cammaroto, et al. "Oxidative Stress and Inflammation Biomarker Expression in Obstructive Sleep Apnea Patients." Journal of Clinical Medicine 10, no. 2 (January 13, 2021): 277. http://dx.doi.org/10.3390/jcm10020277.

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Obstructive Sleep Apnea Syndrome (OSAS) is a respiratory sleep disorder characterised by repeated episodes of partial or complete obstruction of the upper airway during the night. This obstruction usually occurs with a reduction (hypopnea) or complete cessation (apnea) of the airflow in the upper airways with the persistence of thoracic-diaphragmatic respiratory movements. During the hypopnea/apnea events, poor alveolar ventilation reduces the oxygen saturation in the arterial blood (SaO2) and a gradual increase in the partial arterial pressure of carbon dioxide (PaCO2). The direct consequence of the intermittent hypoxia is an oxidative imbalance, with reactive oxygen species production and the inflammatory cascade’s activation with pro and anti-inflammatory cytokines growth. Tumour necrosis factors, inflammatory cytokines (IL2, IL4, IL6), lipid peroxidation, and cell-free DNA have been found to increase in OSAS patients. However, even though different risk-related markers have been described and analysed in the literature, it has not yet been clarified whether specified inflammatory bio-markers better correlates with OSAS diagnosis and its clinical evolution/comorbidities. We perform a scientific literature review to discuss inflammatory and oxidative stress biomarkers currently tested in OSAS patients and their correlation with the disease’s severity and treatment.

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Ayeni, T. I., and H. P. Roper. "Pulmonary hypertension resulting from upper airways obstruction in Down's syndrome." Journal of the Royal Society of Medicine 91, no. 6 (June 1998): 321–22. http://dx.doi.org/10.1177/014107689809100612.

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Massoth, Landon, Cody Anderson, and Kibwei A. McKinney. "Asthma and Chronic Rhinosinusitis: Diagnosis and Medical Management." Medical Sciences 7, no. 4 (March 27, 2019): 53. http://dx.doi.org/10.3390/medsci7040053.

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Asthma is a prevalent inflammatory condition of the lower airways characterized byvariable and recurring symptoms, reversible airflow obstruction, and bronchialhyperresponsiveness (BHR). Symptomatically, these patients may demonstrate wheezing,breathlessness, chest tightness, and coughing. This disease is a substantial burden to a growingpopulation worldwide that currently exceeds 300 million individuals. This is a condition that isfrequently encountered, but often overlooked in the field of otolaryngology. In asthma, comorbidconditions are routinely present and contribute to respiratory symptoms, decreased quality of life,and poorer asthma control. It is associated with otolaryngic diseases of the upper airways includingallergic rhinitis (AR) and chronic rhinosinusitis (CRS). These conditions have been linkedepidemiologically and pathophysiologically. Presently, they are considered in the context of theunified airway theory, which describes the upper and lower airways as a single functional unit.Thus, it is important for otolaryngologists to understand asthma and its complex relationships tocomorbid diseases, in order to provide comprehensive care to these patients. In this article, wereview key elements necessary for understanding the evaluation and management of asthma andits interrelatedness to CRS.

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Price, Scott D., Donald B. Hawkins, and Emily J. Kahlstrom. "Tonsil and Adenoid Surgery for Airway Obstruction: Perioperative Respiratory Morbidity." Ear, Nose & Throat Journal 72, no. 8 (August 1993): 526–31. http://dx.doi.org/10.1177/014556139307200806.

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A series of 160 consecutive patients undergoing tonsil and adenoid surgery for upper airway obstruction is reported. The ages ranged from 8 months to 13 years. Sixty-seven percent were 2, 3, or 4 years of age. All were routinely admitted overnight postoperatively. Forty-five (28%) remained in the hospital longer than one night (2 to 20 days). Postoperative respiratory problems were the reason for prolonged hospital stay in 30 of these 45 patients. Preoperative “danger-signals” of potential postoperative respiratory problems were: a history of severe obstructive symptoms with apnea and moderate or strongly positive sleep study, daytime somnolence, need for urgent T&A, and cardiomegaly. Risk factors present in a smaller number of patients were obesity, congenital stenosis of airways, and bronchopulmonary dysplasia. We suggest that children with these danger signals not be considered as candidates for outpatient T&A surgery.

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Tanase, Ionut, Claudiu Manea, and Codrut Sarafoleanu. "Polysomnography outcomes on patients with obstructive sleep apnea after upper airways repermeabilization surgery." Romanian Journal of Rhinology 8, no. 30 (June 1, 2018): 103–15. http://dx.doi.org/10.2478/rjr-2018-0011.

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Abstract BACKGROUND. Sleep apnea is a pathology with an ever-increasing spread, the causes being the most diverse. In this study we focus on sleep breathing disorders caused by nasal obstruction and also by soft palate and uvula anatomical changes. The right treatment recommended in this pathology according to the American Academy Sleep Medicine (AASM) is non-invasive ventilation – positive airway pressure (CPAP). A substantial percentage of patients with obstructive sleep apnea seek alternatives to CPAP and the solution for this can be upper airway surgery. OBJECTIVE. The attempt to demonstrate the viability of upper respiratory tract surgery as an alternative to CPAP treatment, demonstrating objectives by pre- and postoperative polysomnographic control. RESULTS. Aggregating the data from all 54 patients with nasal obstruction and pharyngeal modifications, we observed a decrease in AHI from 20.406/h to 15.86/h, representing 32.36%, an improvement in sleep architecture and especially REM sleep from 41.5 minutes initially to 67.8 minutes (increased value with 63.37 percent). CONCLUSION. The benefits of nasopharyngeal repermeabilization surgery are represented by decreasing the severity of respiratory events and, second to this, lowering the number of arousals. By reducing the number of arousals, one will obtain a better percentage regarding the deep sleep phase - REM, having a beneficial effect on reducing the daytime sleepiness – which is a major symptom that patients are present.

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TOADER, Corneliu, Mioriţa TOADER, Andreea ŞERBĂNICĂ, Mircea DRĂGHICI, Alina OPREA, and Iolanda Cristina VIVISENCO. "Pediatric obstructive sleep apneea – surgical treatment." Romanian Journal of Medical Practice 10, no. 2 (June 30, 2015): 182–86. http://dx.doi.org/10.37897/rjmp.2015.2.16.

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Obstructive sleep apnea is characterized by recurrent episodes of partial or complete obstruction of upper respiratory airways which appear during sleep and lead to the decrease of oxygen saturation and numerous awakenings. The symptomatology in pediatric obstructive sleep apnea is very different from the adult type in many aspects. The gold standard examination for diagnosis and evaluation of severity is polysomnography. The authors present their experience in the surgical tratament of children with obstructive sleep apnea. It is outlined a group of patient enrolled during a period of 5 years (2010-2014) who had their tonsils reduced through coblation and radiofrequency techniques.

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Lyons, T. J., and S. Variend. "Posterior cleft larynx associated with hamartoma:." Journal of Laryngology & Otology 102, no. 5 (May 1988): 471–72. http://dx.doi.org/10.1017/s0022215100105389.

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SummaryPosterior cleft larynx associated with a local hamartoma is a rare malformation complex. Clinical diagnosis may be elusive. We report such a combination in a newborn infant dying soon after birth with upper airways obstruction.

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Attali, Valérie, Olivier Jacq, Karine Martin, Isabelle Arnulf, and Thomas Similowski. "Osteopathic Manipulation of the Sphenopalatine Ganglia Versus Sham Manipulation, in Obstructive Sleep Apnoea Syndrom: A Randomised Controlled Trial." Journal of Clinical Medicine 11, no. 1 (December 24, 2021): 99. http://dx.doi.org/10.3390/jcm11010099.

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(1) Background: osteopathic manipulation of the sphenopalatine ganglia (SPG) blocks the action of postganglionic sensory fibres. This neuromodulation can reduce nasal obstruction and enhance upper airway stability. We investigated the manipulation of the SPG in 31 patients with obstructive sleep apnoea syndrome (OSAS); (2) Methods: Randomised, controlled, double-blind, crossover study. Participants received active (AM), then sham manipulation (SM), or vice versa. The primary endpoint was apnoea-hypopnoea index (AHI). Secondary endpoints were variation of nasal obstruction evaluated by peak nasal inspiratory flow (PNIF) and upper airways stability evaluated by awake critical closing pressure [awake Pcrit]), at 30 min and 24 h. Schirmer’s test and pain were assessed immediately post-manipulation. Tactile/gustatory/olfactory/auditory/nociceptive/visual sensations were recorded. Adverse events were collected throughout. (3) Results: SPG manipulation did not reduce AHI (p = 0.670). PNIF increased post-AM but not post-SM at 30 min (AM-SM: 18 [10; 38] L/min, p = 0.0001) and 24 h (23 [10; 30] L/min, p = 0.001). There was no significant difference on awake Pcrit (AM-SM) at 30 min or 24 h). Sensations were more commonly reported post-AM (100% of patients) than post-SM (37%). Few adverse events and no serious adverse events were reported. (4) Conclusions: SPG manipulation is not supported as a treatment for OSAS but reduced nasal obstruction. This effect remains to be confirmed in a larger sample before using this approach to reduce nasal congestion in CPAP-treated patients or in mild OSAS.

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Gittoes, N. J. L., M. R. Miller, J. Daykin, M. C. Sheppard, and J. A. Franklyn. "Upper airways obstruction in 153 consecutive patients presenting with thyroid enlargement." BMJ 312, no. 7029 (February 24, 1996): 484. http://dx.doi.org/10.1136/bmj.312.7029.484.

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Bhatawadekar, S. A., D. Leary, V. de Lange, U. Peters, S. Fulton, P. Hernandez, C. McParland, and G. N. Maksym. "Reactance and elastance as measures of small airways response to bronchodilator in asthma." Journal of Applied Physiology 127, no. 6 (December 1, 2019): 1772–81. http://dx.doi.org/10.1152/japplphysiol.01131.2018.

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Bronchodilation alters both respiratory system resistance (Rrs) and reactance (Xrs) in asthma, but how changes in Rrs and Xrs compare, and respond differently in health and asthma, in reflecting the contributions from the large and small airways has not been assessed. We assessed reversibility using spirometry and oscillometry in healthy and asthma subjects. Using a multibranch airway-tree model with the mechanics of upper airway shunt, we compared the effects of airway dilation and small airways recruitment to explain the changes in Rrs and Xrs. Bronchodilator decreased Rrs by 23.0 (19.0)% in 18 asthma subjects and by 13.5 (19.5)% in 18 healthy subjects. Estimated respiratory system elastance (Ers) decreased by 23.2 (21.4)% in asthma, with no significant decrease in healthy subjects. With the use of the model, airway recruitment of 15% across a generation of the small airways could explain the changes in Ers in asthma with no recruitment in healthy subjects. In asthma, recruitment accounted for 40% of the changes in Rrs, with the remaining explained by airway dilation of 6.8% attributable largely to the central airways. Interestingly, the same dilation magnitude explained the changes in Rrs in healthy subjects. Shunt only affected Rrs of the model. Ers was unaltered in health and unaffected by shunt in both groups. In asthma, Ers changed comparably to Rrs and could be attributed to small airways, while the change in Rrs was split between large and small airways. This implies that in asthma Ers sensed through Xrs may be a more effective measure of small airways obstruction and recruitment than Rrs. NEW & NOTEWORTHY This is the first study to quantify to relative contributions of small and large airways to bronchodilator response in healthy subjects and patients with asthma. The response of the central airways to bronchodilator was similar in magnitude in both study groups, whereas the response of the small airways was significant among patients with asthma. These results suggest that low-frequency reactance and derived elastance are both sensitive measures of small airway function in asthma.

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Sanna, A., C. Veriter, and D. Stanescu. "Upper airway obstruction induced by negative-pressure ventilation in awake healthy subjects." Journal of Applied Physiology 75, no. 2 (August 1, 1993): 546–52. http://dx.doi.org/10.1152/jappl.1993.75.2.546.

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Negative-pressure ventilation (NPV) induces sleep-related upper airway obstruction. However, the precise mechanism and site of upper airway obstruction during NPV have not been worked out. We studied seven awake healthy volunteers (23–30 yr old) in an Emerson tank respirator. Subjects had the head outside the iron lung and breathed through a pneumotachograph, which yielded the airflow (V) signal. Supraglottic pressure (Psg) was measured with a catheter with the tip at the retroepiglottic level. Diaphragmatic electromyograms (EMGdi) were obtained from an esophageal bipolar electrode. Tidal volume was measured with an inductance plethysmograph. Measurements were done at -10, -20, and -30 cmH2O. At each pressure run subjects were asked to repeatedly relax or to actively breathe in phase with the respirator. Subjects had been previously trained to relax during NPV. During the relax runs there was no EMGdi activity. Stridor or wheezing occurred in all seven subjects during the relax runs but not during the active runs. Two patterns were associated with NPV during relax runs. One pattern was decreases in both V and Psg followed by zero values of these indexes, which corresponded to an inspiratory narrowing and closure of the glottis. These changes were visualized by fiber-optic bronchoscopy in one subject. The second pattern was a decrease in V and increase in Psg, which corresponded to an inspiratory supraglottic obstruction. In five subjects a supraglottic pattern was observed, whereas in two subjects glottic closure was seen. We conclude that muscular relaxation during NPV produces a decrease in the caliber of the upper airways at the glottic or supraglottic level. An uncoupling of upper airway muscle activity and the diaphragm might be the mechanism responsible for these changes.

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Malik, Kamran Zamurrad, Ameer Abdullah, and Tarique Ahmed Maka. "SPONTANEOUS SUBLINGUAL HEMATOMA; A RARE EMERGENCY." PAFMJ 71, no. 3 (June 30, 2021): 1121–23. http://dx.doi.org/10.51253/pafmj.v71i3.3172.

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Sublingual hematoma or pseudo-Ludwig’s phenomenon, is a rare entity seen in anticoagulated patients and can precipitate upper airway obstruction. We present a case of sublingual haematoma with huge swelling in the floor of mouth that impending airway compromise in a mitral valve replaced patient with ominously deranged coagulation profile. Multiple cases reported in the literature of spontaneous sub-mental hematoma with varying management plans, including: conservative management with close observation in IMCU/ICU, prophylactically securing the airways with elective intubation and/or emergency tracheostomy. Some authors proposed an evacuation the hematoma through an incision along the floor of the mouth. This case was kept under intensive care with strict vitals and airway monitoring and managed conservatively.

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Livraghi-Butrico, Alessandra, Barbara R. Grubb, Elizabeth J. Kelly, Kristen J. Wilkinson, Huifang Yang, Marianne Geiser, Scott H. Randell, Richard C. Boucher, and Wanda K. O'Neal. "Genetically determined heterogeneity of lung disease in a mouse model of airway mucus obstruction." Physiological Genomics 44, no. 8 (April 15, 2012): 470–84. http://dx.doi.org/10.1152/physiolgenomics.00185.2011.

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Mucus clearance is an important airway innate defense mechanism. Airway-targeted overexpression of the epithelial Na+channel β-subunit [encoded by sodium channel nonvoltage gated 1, beta subunit ( Scnn1b)] in mice [ Scnn1b-transgenic (Tg) mice] increases transepithelial Na+absorption and dehydrates the airway surface, which produces key features of human obstructive lung diseases, including mucus obstruction, inflammation, and air-space enlargement. Because the first Scnn1b-Tg mice were generated on a mixed background, the impact of genetic background on disease phenotype in Scnn1b-Tg mice is unknown. To explore this issue, congenic Scnn1b-Tg mice strains were generated on C57BL/6N, C3H/HeN, BALB/cJ, and FVB/NJ backgrounds. All strains exhibited a two- to threefold increase in tracheal epithelial Na+absorption, and all developed airway mucus obstruction, inflammation, and air-space enlargement. However, there were striking differences in neonatal survival, ranging from 5 to 80% (FVB/NJ<BALB/cJ<C3H/HeN<C57BL/6N), which correlated with the incidence of upper airway mucus plugging and the levels of Muc5b in bronchoalveolar lavage. The strains also exhibited variable Clara cell necrotic degeneration in neonatal intrapulmonary airways and a variable incidence of pulmonary hemorrhage and lung atelectasis. The spontaneous occurrence of a high surviving BALB/cJ line, which exhibited delayed onset of Na+hyperabsorption, provided evidence that: 1) air-space enlargement and postnatal death were only present when Na+hyperabsorption occurred early, and 2) inflammation and mucus obstruction developed whenever Na+hyperabsorption was expressed. In summary, the genetic context and timing of airway innate immune dysfunction critically determines lung disease phenotype. These mouse strains may be useful to identify key modifier genes and pathways.

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Anderson, K. D., A. Cole, C. B. Chuo, and R. Slator. "Home Management of Upper Airway Obstruction in Pierre Robin Sequence Using a Nasopharyngeal Airway." Cleft Palate-Craniofacial Journal 44, no. 3 (May 2007): 269–73. http://dx.doi.org/10.1597/06-020.

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Objective: This unit has reported management of infants with Pierre Robin Sequence (PRS) and upper airway obstruction using nasopharyngeal airways and nutritional support until enough growth takes place for the infant to thrive. There was a mean hospital stay of 60 days. This long in-patient stay prompted review of our management protocols and consideration of treatment at home. This paper reports our experience of managing infants with PRS at home using a nasopharyngeal airway and nasogastric feeding tube and reviews whether such management reduces in-patient stay while remaining safe and effective. Design: Retrospective review of cases referred over a 3.5-year period. Comparison is made with the unit's previously published results. Patients: Thirteen PRS infants were referred to the West Midlands Regional Cleft service and required transfer to Birmingham Children's Hospital for specialist assessment and airway control. Interventions: The parents of 12 infants underwent training to manage the airway and feeding tube. Treatment then continued at home. Outcome measures: In-patient episode, rate of weight gain, and complication rate were used. Results: The median hospital stay was 19.5 days compared to 54 days previously. The median rate of weight gain was 34 g/d. There were no complications or readmissions. Conclusion: This series demonstrates the revised management protocol followed has reduced in-patient stays and remained effective, with infants continuing to thrive after discharge home, and has a low complication rate.

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Hassan, W. U., and A. F. Henderson. "Cough and stridor: who should investigate the patient?" Journal of Laryngology & Otology 107, no. 7 (July 1993): 639. http://dx.doi.org/10.1017/s0022215100123953.

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Stridor is usually produced by obstruction in the upper airways. We present a case of stridor referred to the ENT Department in whom an endoscopic examination as far as the lower trachea showed no abnormality. A subsequent bronchoscopy in the Chest Department revealed a tumour in the right main bronchus.

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Mostafavi, Said, George S. Csathy, Gary Bellack, and Zab Mohsenifar. "Obstruction of Upper Airways Complicating Tracheostomy and Use of Neodymium Yag Laser." Respiration 59, no. 3 (1992): 176–77. http://dx.doi.org/10.1159/000196052.

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DAVIES, S. "UPPER AIRWAYS OBSTRUCTION AND CEREBROVASCULAR ACCIDENT IN CHILDREN WITH SICKLE CELL ANAEMIA." Lancet 334, no. 8657 (July 1989): 283–84. http://dx.doi.org/10.1016/s0140-6736(89)90477-7.

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King, Paul T. "The Role of the Immune Response in the Pathogenesis of Bronchiectasis." BioMed Research International 2018 (2018): 1–12. http://dx.doi.org/10.1155/2018/6802637.

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Bronchiectasis is a prevalent respiratory condition characterised by permanent and abnormal dilation of the lung airways (bronchi). There are a large variety of causative factors that have been identified for bronchiectasis; all of these compromise the function of the immune response to fight infection. A triggering factor may lead to the establishment of chronic infection in the lower respiratory tract. The bacteria responsible for the lower respiratory tract infection are usually found as commensals in the upper respiratory tract microbiome. The consequent inflammatory response to infection is largely responsible for the pathology of this condition. Both innate and adaptive immune responses are activated. The literature has highlighted the central role of neutrophils in the pathogenesis of bronchiectasis. Proteases produced in the lung by the inflammatory response damage the airways and lead to the pathological dilation that is the pathognomonic feature of bronchiectasis. The small airways demonstrate infiltration with lymphoid follicles that may contribute to localised small airway obstruction. Despite aggressive treatment, most patients will have persistent disease. Manipulating the immune response in bronchiectasis may potentially have therapeutic potential.

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Masárová, Michaela, Petr Matoušek, Ondřej Jor, Vilém Novák, Adéla Vrtková, Vojtěch Kubec, Karol Zeleník, Pavel Komínek, and Martin Formánek. "Sleep Endoscopy with Positive Airway Pressure: A Method for Better Compliance and Individualized Treatment of Patients with Obstructive Sleep Apnea." Life 12, no. 12 (December 15, 2022): 2108. http://dx.doi.org/10.3390/life12122108.

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In this study, we aimed to observe the effects of positive airway pressure (PAP) on individual levels of obstruction during drug-induced sleep endoscopy (DISE) of the upper airways (UA), to evaluate at which pressures the obstruction disappeared or worsened, and to identify cases in which PAP was ineffective. This prospective study was conducted from June 2018 to June 2022. PAP testing was performed during DISE in patients with moderate and severe OSA. The pressure was gradually increased over the range from 6.0 to 18.0 hPa. Our findings were evaluated using the VOTE classification. The examination was performed in 56 patients, with a median apnea–hypopnea index (AHI) of 26.4. Complete obstruction of the soft palate was observed in 51/56 patients (91%), oropharyngeal obstruction in 15/56 patients (27%), tongue base obstruction in 23/56 patients (41%), and epiglottic collapse in 16/56 patients (29%). PAP was most effective in cases of complete oropharyngeal obstruction, and least effective in cases of epiglottic collapse, where it was ineffective in 11/16 patients. DISE with PAP is a simple diagnostic method that can be helpful for identifying anatomic and dynamic reasons for PAP intolerance. The main indication is ineffective PAP treatment.

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Journal articles on the topic 'Upper airways obstruction'

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