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American Academy of Pediatrics
Article

Upper Airway Obstruction

Jordan Virbalas and Lee Smith
Pediatrics in Review February 2015, 36 (2) 62-73; DOI: https://doi.org/10.1542/pir.36-2-62
Jordan Virbalas
*Department of Otorhinolaryngology–Head and Neck Surgery, Albert Einstein College of Medicine, Bronx, NY.
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Lee Smith
†Department of Otolaryngology, Steven and Alexandra Cohen Children’s Medical Center, Hofstra North Shore LIJ School of Medicine, New Hyde Park, NY.
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  • Correction - May 01, 2015

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  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.
  • AUTHOR DISCLOSURE

    Drs Virbalas and Smith have disclosed no financial relationships relevant to this article. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device.

  • Abbreviations:
    BT:
    bacterial tracheitis
    CT:
    computed tomography
    HIB:
    Haemophilus influenzae type B
  • Educational Gap

    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.

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    Table.

    Common Causes of Upper Airway Obstruction

    Objectives

    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.

    Laryngomalacia

    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 …

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    In this issue

    Pediatrics in Review: 36 (2)
    Pediatrics in Review
    Vol. 36, Issue 2
    1 Feb 2015
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    Upper Airway Obstruction
    Jordan Virbalas, Lee Smith
    Pediatrics in Review Feb 2015, 36 (2) 62-73; DOI: 10.1542/pir.36-2-62

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    Upper Airway Obstruction
    Jordan Virbalas, Lee Smith
    Pediatrics in Review Feb 2015, 36 (2) 62-73; DOI: 10.1542/pir.36-2-62
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    • Article
      • Educational Gap
      • Objectives
      • Laryngomalacia
      • Epiglottitis
      • Laryngotracheitis
      • Recurrent or Atypical Croup
      • Bacterial Tracheitis
      • Tracheomalacia
      • References
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