Airway obstruction

Airway obstruction is a life-threatening condition and requires urgent attention.

Upper airway obstruction

Causes

The causes of upper airway obstructions can be acute or chronic. Acute causes of upper airway obstruction include foreign body aspiration, blunt trauma to the neck, infection, and swelling due to allergies or other inflammatory conditions. In children, viral infections such as croup or epiglottitis are frequent causes. Adults are more likely to experience obstruction from enlargement of the tonsils or vocal cord paralysis. Obstructive sleep apnea is the most common chronic cause of upper airway obstruction.

Symptoms

Stridor is a high-pitched sound which occurs during breathing and is associated with obstruction at the level of the larynx. Difficulty swallowing and changes in voice are common symptoms. If there is total obstruction, severe respiratory distress or cyanosis due to hypoxia (lack of oxygen in the blood) can occur.

Diagnosis

With acute upper airway obstruction, respiratory distress can rapidly lead to respiratory failure without appropriate management necessitating urgent and comprehensive assessment of ABCs (airway, breathing, and circulation).

Imaging studies, including x-rays and CT scans, can aid diagnosis and quickly assess the obstruction's extent. For children, ultrasound or MRI are preferred as they do not involve radiation. Flexible laryngoscopy or bronchoscopy can directly visualize the airway.

Management

Treatment depends on how severe the patient's condition is and the cause of the obstruction. If the patient is choking on a foreign body, the Heimlich maneuver can be used. More invasive methods, such as intubation, may be necessary to secure the airway. In severe cases, intubation may be difficult and a cricothyrotomy or tracheostomy may be necessary.

Infections typically cause obstruction by swelling and are usually treated with antibiotics or corticosteroids to reduce inflammation. For causes like tumors or abscesses, surgical removal may be required.

Prognosis

With prompt treatment, outcomes are usually favorable. This is especially true for reversible conditions, like foreign body aspiration. Chronic conditions, like vocal cord paralysis and sleep apnea, may need ongoing care. If managed well, they usually have good outcomes.

Complications

Untreated or prolonged upper airway obstruction can cause severe, life-threatening complications.

• Hypoxia: Low blood oxygen can cause confusion and unconsciousness. It can also lead to cardiac arrest if not treated.
• Aspiration pneumonia: Particles entering the lungs can cause infections.
• Structural changes: Repeating obstruction or trauma may scar or narrow the upper airway. This is called subglottic or tracheal stenosis.
• Voice changes: Chronic damage to the vocal cords may cause permanent voice changes or loss.
• Cardiac arrest: Severe obstruction can cause asphyxiation, leading to heart failure if untreated.