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Rhinitis /ranats/ is a medical term for irritation and inflammation of the mucous membrane

inside the nose. Common symptoms of rhinitis are a stuffy nose, runny nose, and post-nasal drip.
[1]
The most common kind of rhinitis is allergic rhinitis,[2] which is usually triggered by airborne
allergens such as pollen and dander.[3] Allergic rhinitis may cause additional symptoms, such as
sneezing and nasal itching, coughing, headache,[4] fatigue, malaise, and cognitive impairment.[5][6]
[7]
The allergens may also affect the eyes, causing watery, reddened or itchy eyes and puffiness
around the eyes.[4]
Rhinitis is very common. Allergic rhinitis is more common in some countries than others; in the
United States, about 10%-30% of adults are affected annually.[8]
In rhinitis, the inflammation of the mucous membrane is caused by viruses, bacteria, irritants or
allergens. The inflammation results in the generation of large amounts of mucus, commonly
producing a runny nose, as well as a stuffy nose and post-nasal drip. In the case of allergic
rhinitis, the inflammation is caused by the degranulation of mast cells in the nose. When mast
cells degranulate, they release histamine and other chemicals,[9] starting an inflammatory process
that can cause symptoms outside the nose, such as fatigue and malaise.[10]

Types[edit]
Rhinitis is categorized into three types: (i) infective rhinitis includes acute and chronic bacterial
infections; (ii) nonallergic (vasomotor) rhinitis includes autonomic, hormonal, drug-induced,
atrophic, and gustatory rhinitis, as well as rhinitis medicamentosa; (iii) allergic rhinitis, triggered
by pollen, mold, animal dander, dust and other similar inhaled allergens.[2]

Infectious[edit]
See also: Common cold and Sinusitis
Rhinitis is commonly caused by a viral or bacterial infection, including the common cold, which
is caused by Rhinoviruses, Coronaviruses, and influenza viruses, others caused by adenoviruses,
human parainfluenza viruses, human respiratory syncytial virus, enteroviruses other than
rhinoviruses, and metapneumovirus, or bacterial sinusitis, which is commonly caused by
Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis. Symptoms of
the common cold include rhinorrhea, sore throat (pharyngitis), cough, congestion, and slight
headache.[citation needed]

Vasomotor rhinitis[edit]
Non-allergic rhinitis refers to runny nose that is not due to allergy. Non-allergic rhinitis can be
classified as either non-inflammatory or inflammatory rhinitis. One very common type of noninflammatory, non-allergic rhinitis that is sometimes confused with allergy is called vasomotor
rhinitis,[11] in which certain nonspecific stimuli, including changes in environment (temperature,

humidity, barometric pressure, or weather); airborne irritants (odors, fumes); dietary factors
(spicy food, alcohol); sexual arousal; and emotional factors.[12] There is still much to be learned
about this entity, but it is thought that these non-allergic triggers cause dilation of the blood
vessels in the lining of the nose, which results in swelling, and drainage. Vasomotor rhinitis can
coexist with allergic rhinitis, and this is called "mixed rhinitis." (Middleton's Allergy Principles
and Practice, seventh edition.) The pathology of vasomotor rhinitis appears to involve
neurogenic inflammation[13] and is as yet not very well understood. Vasomotor rhinitis appears to
be significantly more common in women than men, leading some researchers to believe that
hormones play a role. In general, age of onset occurs after 20 years of age, in contrast to allergic
rhinitis which can be developed at any age. Individuals suffering from vasomotor rhinitis
typically experience symptoms year-round, though symptoms may be exacerbated in the spring
and autumn when rapid weather changes are more common.[14] An estimated 17 million United
States citizens have vasomotor rhinitis. The antihistamines azelastine and olopatadine, applied as
nasal sprays, may both be effective for vasomotor rhinitis.[15][16] Fluticasone propionate or
budesonide (both are steroids) in nostril spray form may also be used for symptomatic treatment.

Allergic[edit]
Main article: Allergic rhinitis

Pollen grains from a variety of common plants can cause hay fever.
Allergic rhinitis or hay fever may follow when an allergen such as pollen or dust is inhaled by an
individual with a sensitized immune system, triggering antibody production. These antibodies
mostly bind to mast cells, which contain histamine. When the mast cells are stimulated by pollen
and dust, histamine (and other chemicals) are released. This causes itching, swelling, and mucus
production. Symptoms vary in severity between individuals. Very sensitive individuals can
experience hives or other rashes. Particulate matter in polluted air and chemicals such as chlorine
and detergents, which can normally be tolerated, can greatly aggravate the condition.[citation needed]
Characteristic physical findings in individuals who have allergic rhinitis include conjunctival
swelling and erythema, eyelid swelling, lower eyelid venous stasis, lateral crease on the nose,
swollen nasal turbinates, and middle ear effusion.[17]
Even if a person has negative skin-prick, intradermal and blood tests for allergies, they may still
have allergic rhinitis, from a local allergy in the nose. This is called local allergic rhinitis.[18]

Many people who were previously diagnosed with nonallergic rhinitis may actually have local
allergic rhinitis.[19]

Rhinitis medicamentosa[edit]
Main article: Rhinitis medicamentosa
It is a condition of rebound nasal congestion brought on by extended use of topical decongestants
(e.g., oxymetazoline, phenylephrine, xylometazoline, and naphazoline nasal sprays) that work by
constricting blood vessels in the lining of the nose.

Chronic atrophic rhinitis[edit]


Main article: Chronic atrophic rhinitis
Chronic rhinitis in form of atrophy of the mucous membrane and glands.

Rhinitis sicca[edit]
Chronic form of dryness of the mucous membranes.

Polypous rhinitis[edit]
Chronic rhinitis associated with polyps in the nasal cavity.

Management[edit]
The management of rhinitis depends on the underlying cause. High-dose administration of
Vitamin B12 has been additionally validated to stimulate the activity of the body's TH1
suppressor T-Cells, which then down-regulates the over-production of the allergen antibody IgE
in allergic individuals which could decrease both near and long term manifestations of rhinitis
symptomology.[20][21]
Sinusitis or rhinosinusitis is inflammation of the paranasal sinuses. It can be due to infection,
allergy, or autoimmune issues. Most cases are due to a viral infection and resolve over the course
of 10 days. It is a common condition, with over 24 million cases annually in the U.S.[1]

Classification[edit]
Sinusitis (or rhinosinusitis) is defined as an inflammation of the mucous membrane that lines the
paranasal sinuses and is classified chronologically into several categories:[2]

acute rhinosinusitis a new infection that may last up to four weeks and can be
subdivided symptomatically into severe and non-severe;

recurrent acute rhinosinusitis four or more separate episodes of acute sinusitis that
occur within one year;

subacute rhinosinusitis an infection that lasts between four and 12 weeks, and
represents a transition between acute and chronic infection;

chronic rhinosinusitis when the signs and symptoms last for more than 12 weeks; and

acute exacerbation of chronic rhinosinusitis when the signs and symptoms of chronic
rhinosinusitis exacerbate, but return to baseline after treatment.

All these types of sinusitis have similar symptoms, and are thus often difficult to distinguish.
Acute sinusitis is very common. Roughly ninety percent of adults have had sinusitis at some
point in their life.[3]

Acute[edit]
Acute sinusitis is usually precipitated by an earlier upper respiratory tract infection, generally of
viral origin, mostly caused by rhinoviruses, coronaviruses, and influenza viruses, others caused
by adenoviruses, human parainfluenza viruses, human respiratory syncytial virus, enteroviruses
other than rhinoviruses, and metapneumovirus. If the infection is of bacterial origin, the most
common three causative agents are Streptococcus pneumoniae, Haemophilus influenzae, and
Moraxella catarrhalis.[4] Until recently, Haemophilus influenzae was the most common bacterial
agent to cause sinus infections. However, introduction of the H. influenza type B (Hib) vaccine
has dramatically decreased H. influenza type B infections and now non-typable H. influenza
(NTHI) are predominantly seen in clinics. Other sinusitis-causing bacterial pathogens include
Staphylococcus aureus and other streptococci species, anaerobic bacteria and, less commonly,
gram negative bacteria. Viral sinusitis typically lasts for 7 to 10 days,[4] whereas bacterial
sinusitis is more persistent. Approximately 0.5% to 2% of viral sinusitis results in subsequent
bacterial sinusitis. It is thought that nasal irritation from nose blowing leads to the secondary
bacterial infection.[5]
Acute episodes of sinusitis can also result from fungal invasion. These infections are typically
seen in patients with diabetes or other immune deficiencies (such as AIDS or transplant patients
on immunosuppressive anti-rejection medications) and can be life threatening. In type I
diabetics, ketoacidosis can be associated with sinusitis due to mucormycosis.[6]
Chemical irritation can also trigger sinusitis, commonly from cigarette smoke and chlorine
fumes.[7] Rarely, it may be caused by a tooth infection.[4]

Chronic[edit]
Chronic sinusitis, by definition, lasts longer than three months and can be caused by many
different diseases that share chronic inflammation of the sinuses as a common symptom.
Symptoms of chronic sinusitis may include any combination of the following: nasal congestion,
facial pain, headache, night-time coughing, an increase in previously minor or controlled asthma

symptoms, general malaise, thick green or yellow discharge, feeling of facial 'fullness' or
'tightness' that may worsen when bending over, dizziness, aching teeth, and/or halitosis.[2][verification
needed]
Each of these symptoms has multiple other possible causes, which should be considered
and investigated as well. Unless complications occur, fever is not a feature of chronic sinusitis.
[citation needed]
Often chronic sinusitis can lead to anosmia, a reduced sense of smell.[2] In a small
number of cases, acute or chronic maxillary sinusitis is associated with a dental infection.
Vertigo, lightheadedness, and blurred vision are not typical in chronic sinusitis and other causes
should be investigated.
Chronic sinusitis cases are subdivided into cases with polyps and cases without polyps. When
polyps are present, the condition is called chronic hyperplastic sinusitis; however, the causes are
poorly understood[4] and may include allergy, environmental factors such as dust or pollution,
bacterial infection, or fungus (either allergic, infective, or reactive). Non-allergic factors, such as
vasomotor rhinitis, can also cause chronic sinus problems.[citation needed] Abnormally narrow sinus
passages, such as having a deviated septum, can impede drainage from the sinus cavities and be a
contributing factor.[citation needed]
Chronic rhinosinusitis represents a multifactorial inflammatory disorder, rather than simply a
persistent bacterial infection.[4] The medical management of chronic rhinosinusitis is now
focused upon controlling the inflammation that predisposes patients to obstruction, reducing the
incidence of infections. However, all forms of chronic rhinosinusitis are associated with impaired
sinus drainage and secondary bacterial infections. Most individuals require initial antibiotics to
clear any infection and intermittently afterwards to treat acute exacerbations of chronic
rhinosinusitis.
A combination of anaerobic and aerobic bacteria, are detected in conjunction with chronic
sinusitis. Also isolated are Staphylococcus aureus (including methicilin resistant S.aureus ) and
coagulase-negative Staphylococci and Gram negative enteric organisms can be isolated.
Typically antibiotic treatment provides only a temporary reduction in inflammation, although
hyperresponsiveness of the immune system to bacteria has been proposed as a possible cause of
sinusitis with polyps (chronic hyperplastic sinusitis).[citation needed]
Attempts have been made to provide a more consistent nomenclature for subtypes of chronic
sinusitis. The presence of eosinophils in the mucous lining of the nose and paranasal sinuses has
been demonstrated for many patients, and this has been termed eosinophilic mucin rhinosinusitis
(EMRS). Cases of EMRS may be related to an allergic response, but allergy is not often
documented, resulting in further subcategorization into allergic and non-allergic EMRS.[8]
A more recent, and still debated, development in chronic sinusitis is the role that fungus plays in
this disease. Fungus can be found in the nasal cavities and sinuses of most patients with sinusitis,
but can also be found in healthy people as well.[citation needed] It remains unclear if fungus is a
definite factor in the development of chronic sinusitis and if it is, what the difference may be
between those who develop the disease and those who remain free of symptoms. Trials of
antifungal treatments have had mixed results.

By location[edit]

There are several paired paranasal sinuses, including the frontal, ethmoid, maxillary and
sphenoid sinuses. The ethmoid sinuses is further subdivided into anterior and posterior ethmoid
sinuses, the division of which is defined as the basal lamella of the middle turbinate. In addition
to the severity of disease, discussed below, sinusitis can be classified by the sinus cavity which it
affects:

Maxillary can cause pain or pressure in the maxillary (cheek) area (e.g., toothache,
headache) (J01.0/J32.0)

Frontal can cause pain or pressure in the frontal sinus cavity (located above eyes),
headache (J01.1/J32.1)

Ethmoid can cause pain or pressure pain between/behind the eyes and headaches
(J01.2/J32.2)

Sphenoid can cause pain or pressure behind the eyes, but often refers to the vertex, or
top of the head

Recent theories of sinusitis indicate that it often occurs as part of a spectrum of diseases that
affect the respiratory tract (i.e., the "one airway" theory) and is often linked to asthma.[9][10] All
forms of sinusitis may either result in, or be a part of, a generalized inflammation of the airway,
so other airway symptoms, such as cough, may be associated with it.

Signs and symptoms[edit]


Headache/facial pain or pressure of a dull, constant, or aching sort over the affected sinuses is
common with both acute and chronic stages of sinusitis. This pain is typically localized to the
involved sinus and may worsen when the affected person bends over or when lying down. Pain
often starts on one side of the head and progresses to both sides.[11] Acute and chronic sinusitis
may be accompanied by thick nasal discharge that is usually green in color and may contain pus
(purulent) and/or blood.[12] Often a localized headache or toothache is present, and it is these
symptoms that distinguish a sinus-related headache from other types of headaches, such as
tension and migraine headaches. Infection of the eye socket is possible, which may result in the
loss of sight and is accompanied by fever and severe illness. Another possible complication is the
infection of the bones (osteomyelitis) of the forehead and other facial bones Pott's puffy tumor.
[11]

Sinus infections can also cause inner ear problems due to the congestion of the nasal passages.
This can be demonstrated by dizziness, "a pressurized or heavy head", or vibrating sensations in
the head. Other symptoms of sinusitis include bad breath and Post-nasal drip.
Recent studies suggest that up to 90% of "sinus headaches" are actually migraines.[13][14][verification
needed]
The confusion occurs in part because migraine involves activation of the trigeminal nerves,
which innervate both the sinus region and the meninges surrounding the brain. As a result, it is
difficult to accurately determine the site from which the pain originates. Additionally, nasal

congestion can be a common result of migraine headaches, due to the autonomic nerve
stimulation that can also cause tearing (lacrimation) and a runny nose (rhinorrhea).[citation needed] A
study found that patients with "sinus headaches" responded to triptan migraine medications, but
stated dissatisfaction with their treatment when they are treated with decongestants or antibiotics.
[15]
People with migraines do not typically have the thick nasal discharge that is a common
symptom of a sinus infection.[16]

Complications[edit]
Stage
I
II
III
IV
V

Description
Preseptal cellulitis
Orbital cellulitis
Subperiosteal abscess
Orbital abscess
Cavernous sinus septic thrombosis

The close proximity of the brain to the sinuses makes the most dangerous complication of
sinusitis, particularly involving the frontal and sphenoid sinuses, infection of the brain by the
invasion of anaerobic bacteria through the bones or blood vessels. Abscesses, meningitis, and
other life-threatening conditions may result. In extreme cases the patient may experience mild
personality changes, headache, altered consciousness, visual problems, seizures, coma, and
possibly death.[11]
Sinus infection can spread through anastomosing veins or by direct extension to close structures.
Orbital complications were categorized by Chandler et al.[17] into five stages according to their
severity (see table). Contiguous spread to the orbit may result in periorbital cellulitis,
subperiosteal abscess, orbital cellulitis, and abscess. Orbital cellulitis can complicate acute
ethmoiditis if anterior and posterior ethmoidal veins thrombophlebitis enables the spread of the
infection to the lateral or orbital side of the ethmoid labyrinth. Sinusitis may extend to the central
nervous system, where it may cause cavernous sinus thrombosis, retrograde meningitis, and
epidural, subdural, and brain abscesses.[18] Orbital symptoms frequently precede intracranial
spread of the infection . Other complications include sinobronchitis, maxillary osteomyelitis, and
frontal bone osteomyelitis.[19][20][21][22] Osteomyelitis of the frontal bone often originates from a
spreading thrombo-phlebitis. A periostitis of the frontal sinus causes an osteitis and a periostitis
of the outer membrane, which produces a tender, puffy swelling of the forehead.
The diagnosis of these complication can be assisted by noting local tenderness and dull pain, and
can be confirmed by CT and nuclear isotope scanning. The most common microbial causes are
anaerobic bacteria and S. aureus. Treatment includes performing surgical drainage and
administration of antimicrobial therapy. Surgical debridement is rarely required after an extended
course of parenteral antimicrobial therapy.[23] Antibiotics should be administered for at least 6
weeks. Continuous monitoring of patients for possible intracranial complication is advised.

Causes[edit]

Factors which may predispose someone to developing sinusitis include: allergies; structural
abnormalities, such as a deviated septum, small sinus ostia or a concha bullosa; nasal polyps;
carrying the cystic fibrosis gene, though research is still tentative; and prior bouts of sinusitis,
because each instance may result in increased inflammation of the nasal or sinus mucosa and
potentially further narrow the nasal passageways.[citation needed]
Both smoking and second hand smoke are associated with chronic rhinosinusitis.[24]
Maxillary sinusitis may also be of dental origin ("odontogenic sinusitis"),[25] and constitutes a
significant percentage (about 20% of all cases of maxillary sinusitis),[26] given the close
proximity of the teeth and the sinus floor. The cause of this situation is usually a periapical or
periodontal infection of a maxillary posterior tooth, where the inflammatory exudate has eroded
through the bone superiorly to drain into the maxillary sinus. Once an odontogenic infection
involves the maxilary sinus, it is possible that it may then spread to the orbit or to the ethmoid
sinus.[26] Complementary tests based on conventional radiology techniques and modern
technology may be indicated. Their indication is based on the clinical context.
Chronic sinusitis can also be caused indirectly through a common but slight abnormality within
the auditory or Eustachian tube, which is connected to the sinus cavities and the throat. This tube
is usually almost level with the eye sockets but when this sometimes hereditary abnormality is
present, it is below this level and sometimes level with the vestibule or nasal entrance. This
almost always causes some sort of blockage within the sinus cavities ending in infection and
usually resulting in chronic sinusitis.[citation needed]

Pathophysiology[edit]
It has been hypothesized that biofilm bacterial infections may account for many cases of
antibiotic-refractory chronic sinusitis.[27][28][29] Biofilms are complex aggregates of extracellular
matrix and inter-dependent microorganisms from multiple species, many of which may be
difficult or impossible to isolate using standard clinical laboratory techniques.[30] Bacteria found
in biofilms have their antibiotic resistance increased up to 1000 times when compared to freeliving bacteria of the same species. A recent study found that biofilms were present on the
mucosa of 75% of patients undergoing surgery for chronic sinusitis.[31]

Diagnosis[edit]
Acute[edit]
Bacterial and viral acute sinusitis are difficult to distinguish. However, if symptoms last less than
10 days, it is generally considered viral sinusitis. When symptoms last more than 10 days, it is
considered bacterial sinusitis.[32] At this point 30% to 50% of cases are bacterial.[citation needed]
Imaging by either Xray, CT or MRI is generally not recommended unless complications develop.
[32]
Pain caused by sinusitis is sometimes confused for pain caused by pulpitis (toothache) of the
maxillary teeth, and vice versa. Classically, the increased pain when tilting the head forwards
separates sinusitis from pulpitis.

Chronic[edit]
For sinusitis lasting more than 12 weeks a CT scan is recommended.[32] Nasal endoscopy, and
clinical symptoms are also used to make a positive diagnosis.[4] A tissue sample for histology and
cultures can also be collected and tested.[33] Allergic fungal sinusitis (AFS) is often seen in people
with asthma and nasal polyps. In rare cases, sinusoscopy may be made.
Nasal endoscopy involves inserting a flexible fiber-optic tube with a light and camera at its tip
into the nose to examine the nasal passages and sinuses. This is generally a completely painless
(although uncomfortable) procedure which takes between five to ten minutes to complete.

MRI image showing sinusitis. Edema and mucosal thickening appears in both maxillary
sinuses.

A computed tomograph showing infection of the ethmoid sinus

Maxillary sinusitis caused by a dental infection associated with periorbital cellulitis

Treatment[edit]
Conservative[edit]

Nasal irrigation may help with symptoms of chronic sinusitis.[34] Decongestant nasal sprays
containing for example oxymetazoline may provide relief, but these medications should not be
used for more than the recommended period. Longer use may cause rebound sinusitis.[35] Other
recommendations include applying a warm, moist cloth to the affected areas several times a day;
drinking sufficient fluids in order to thin the mucus; and inhaling low temperature steam two to
four times a day.[36]

Antibiotics[edit]
The vast majority of cases of sinusitis are caused by viruses and will therefore resolve without
antibiotics.[4] However, if symptoms do not resolve within 10 days, amoxicillin is a reasonable
antibiotic to use first for treatment[4] with amoxicillin/clavulanate being indicated when the
person's symptoms do not improve after 7 days on amoxicillin alone.[32] Antibiotics are
specifically not recommended in those with mild / moderate disease during the first week of
infection due to risk of adverse effects, antibiotic resistance, and cost.[37] Due to increasing
resistance to amoxicillin the Infectious Diseases Society of America recommends amoxicillinclavulanate as the treatment of choice for acute sinusitis.[38] They also recommend against other
commonly used antibiotics, including azithromycin, clarithromycin and
trimethoprim/sulfamethoxazole, because of growing drug resistance.[38]
Fluoroquinolones, and a newer macrolide antibiotic such as clarithromycin or a tetracycline like
doxycycline, are used in those who have severe allergies to penicillins.[39] Because of increasing
resistance to amoxicillin the 2012 guideline of the Infectious Diseases Society of America
recommends amoxicillin-clavulanate as the initial treatment of choice for bacterial sinusitis.[38]
The guidelines also recommend against other commonly used antibiotics, including
azithromycin, clarithromycin and trimethoprim/sulfamethoxazole, because of growing drug
resistance.
A short-course (37 days) of antibiotics seems to be just as effective as the typical longer-course
(1014 days) of antibiotics for those with clinically diagnosed acute-bacterial sinusitis without
any other severe disease or complicating factors.[40] The IDSA guideline suggest five to seven
days of antibiotics is long enough to treat a bacterial infection without encouraging resistance.
The guideline still do recommend children receive antibiotic treatment for 10 days to two weeks.
[38]

Corticosteroids[edit]
For unconfirmed acute sinusitis, intranasal corticosteroids have not been found to be better than
placebo either alone or in combination with antibiotics.[41] For cases confirmed by radiology or
nasal endoscopy, treatment with corticosteroids alone or in combination with antibiotics is
supported.[42] The benefit however is small.[43]
There is only limited evidence to support short treatment with oral corticosteroids for chronic
rhinosinusitis with nasal polyps.[44][45]

Surgery[edit]

For chronic or recurring sinusitis, referral to an otolaryngologist specialist may be indicated, and
treatment options may include nasal surgery. Surgery should only be considered for those
patients who do not experience sufficient relief from optimal medication.[44][46]
Maxilliary antral washout involves puncturing the sinus and flushing with saline to clear the
mucus. A 1996 study of patients with chronic sinusitis found that washout confers no additional
benefits over antibiotics alone.[47]
A number of surgical approaches can be used to access the sinuses and these have generally
shifted from external/extranasal approaches to intranasal endoscopic ones. The benefit of
Functional Endoscopic Sinus Surgery (FESS) is its ability to allow for a more targeted approach
to the affected sinuses, reducing tissue disruption, and minimizing post-operative complications.
[48]

Another recently developed treatment is balloon sinuplasty. This method, similar to balloon
angioplasty used to "unclog" arteries of the heart, utilizes balloons in an attempt to expand the
openings of the sinuses in a less invasive manner. The utility of this treatment for sinus disease is
still under debate but appears promising.[citation needed]
For persistent symptoms and disease in patients who have failed medical and the functional
endoscopic approaches, older techniques can be used to address the inflammation of the
maxillary sinus, such as the Caldwell-Luc radical antrostomy. This surgery involves an incision
in the upper gum, opening in the anterior wall of the antrum, removal of the entire diseased
maxillary sinus mucosa and drainage is allowed into inferior or middle meatus by creating a
large window in the lateral nasal wall.[49]
Pharyngitis /frndats/ comes from the Greek word pharynx pharanx meaning throat and
the suffix -itis meaning inflammation. It is an inflammation of the throat.[1] In most cases it is
quite painful, and is the most common cause of a sore throat.[2]
Like many types of inflammation, pharyngitis can be acute characterized by a rapid onset and
typically a relatively short course or chronic. Pharyngitis can result in very large tonsils which
cause trouble swallowing and breathing. Pharyngitis can be accompanied by a cough or fever, for
example, if caused by a systemic infection.
Most acute cases are caused by viral infections (4080%), with the remainder caused by bacterial
infections, fungal infections, or irritants such as pollutants or chemical substances.[2][3] Treatment
of viral causes are mainly symptomatic while bacterial or fungal causes may be amenable to
antibiotics and anti-fungal respectively.

Contents
Pharyngitis is a type of inflammation, most commonly caused by an upper respiratory tract
infection. It may be classified as acute or chronic. An acute pharyngitis may be catarrhal,

purulent or ulcerative, depending on the virulence of the causative agent and the immune
capacity of the affected individual. Chronic pharyngitis is the most common otolaringologic
disease and may be catarrhal, hypertrophic or atrophic.
If the inflammation includes tonsillitis, it is called pharyngotonsillitis.[4] Another sub
classification is nasopharyngitis (the common cold).[5]

Cause[edit]
The majority of cases are due to an infectious organism acquired from close contact with an
infected individual.

Infectious[edit]
Viral
These comprise about 4080% of all infectious cases and can be a feature of many different
types of viral infections.[2][3]

Adenovirus the most common of the viral causes. Typically the degree of neck lymph
node enlargement is modest and the throat often does not appear red, although it is very
painful.

Orthomyxoviridae which cause influenza present with rapid onset high temperature,
headache and generalised ache. A sore throat may be associated.

Infectious mononucleosis ("glandular fever") caused by the Epstein-Barr virus. This may
cause significant lymph gland swelling and an exudative tonsillitis with marked redness
and swelling of the throat. The heterophile test can be used if this is suspected.

Herpes simplex virus can cause multiple mouth ulcers.

Measles

Common cold: rhinovirus, coronavirus, respiratory syncytial virus, parainfluenza virus


can cause infection of the throat, ear, and lungs causing standard cold-like symptoms and
often extreme pain.

Bacterial
A number of different bacteria can infect the human throat. The most common is Group A
streptococcus, however others include Corynebacterium diphtheriae, Neisseria gonorrhoeae,
Chlamydophila pneumoniae, and Mycoplasma pneumoniae.[6]
Streptococcal pharyngitis

A case of strep throat


Streptococcal pharyngitis or strep throat is caused by group A beta-hemolytic streptococcus
(GAS).[7] It is the most common bacterial cause of cases of pharyngitis (1530%).[6] Common
symptoms include fever, sore throat, and large lymph nodes. It is a contagious infection, spread
by close contact with an infected individual. A definitive diagnosis is made based on the results
of a throat culture. Antibiotics are useful to both prevent complications and speed recovery.[8]
Fusobacterium necrophorum
Fusobacterium necrophorum are normal inhabitants of the oropharyngeal flora. Occasionally
however it can create a peritonsillar abscess. In 1 out of 400 untreated cases Lemierre's syndrome
occurs.[9]
Diphtheria
Diphtheria is a potentially life threatening upper respiratory infection caused by
Corynebacterium diphtheriae which has been largely eradicated in developed nations since the
introduction of childhood vaccination programs, but is still reported in the Third World and
increasingly in some areas in Eastern Europe. Antibiotics are effective in the early stages, but
recovery is generally slow.[citation needed]
Others
A few other causes are rare, but possibly fatal, and include parapharyngeal space infections:
peritonsillar abscess ("quinsy"), submandibular space infection (Ludwig's angina), and
epiglottitis.[10][11][12]
Fungal

Some cases of pharyngitis are caused by fungal infection such as Candida albicans causing oral
thrush.[citation needed]

Non-infectious[edit]
Pharyngitis may also be caused by mechanical, chemical or thermal irritation, for example cold
air or acid reflux. Some medications may produce pharyngitis such as pramipexole and
antipsychotics.[13][14]

Diagnostic approach[edit]
Points
1 or less
2
3
4 or 5

Modified Centor score


Probability of Strep
Management
<10%
No antibiotic or culture needed
1117%
Antibiotic based on culture or RADT
2835%
52%
Empiric antibiotics

It is hard to differentiate a viral and a bacterial cause of a sore throat based on symptoms alone.
[15]
Thus often a throat swab is done to rule out a bacterial cause.[16]
The modified Centor criteria may be used to determine the management of people with
pharyngitis. Based on 5 clinical criteria, it indicates the probability of a streptococcal infection.[8]
One point is given for each of the criteria:[8]

Absence of a cough

Swollen and tender cervical lymph nodes

Temperature >38.0 C (100.4 F)

Tonsillar exudate or swelling

Age less than 15 (a point is subtracted if age >44)

The McIsaac criteria adds to the Centor:[17]

Age less than 15: add one point

Age greater than 45: subtract one point

The Infectious Disease Society of America however recommends against empirical treatment
and considers antibiotics only appropriate following positive testing.[15] Testing is not needed in

children under three as both group A strep and rheumatic fever are rare, except if they have a
sibling with the disease.[15]

Management[edit]
The majority of time treatment is symptomatic. Specific treatments are effective for bacterial,
fungal, and herpes simplex infections.

Medications[edit]

Analgesics such as NSAIDs and acetaminophen can help reduce the pain associated with
a sore throat. (Note: Don't use salicylates, like aspirin, for influenza: Increased risk of
Reye's syndrome)[18]

Steroids (such as dexamethasone) have been found to be useful for severe pharyngitis.[19]
[20]

Viscous lidocaine relieves pain by numbing the mucus membranes.[21]

Antibiotics are useful if a bacterial infection is the cause of the sore throat. For viral
infections, antibiotics have no effect.[22]

Oral analgesic solutions, the active ingredient usually being Phenol, but also less
commonly Benzocaine, Cetylpyridinium chloride and/or Menthol. Chloraseptic and
Cpacol are two examples of brands of these kinds of analgesics.

Alternative[edit]
See also: Alternative treatments used for the common cold
Alternative medicines are promoted and used for the treatment of sore throats.[23] However, they
are poorly supported by evidence.[23]
Adenoiditis is the inflammation of the adenoid tissue, usually caused by an infection.
Adenoiditis is treated using medication (antibiotics and/or steroids) or surgical intervention.
Adenoiditis may present with cold like symptoms. However, adenoiditis symptoms often persist
for ten or more days, and often include pus like discharge from nose.
The infection cause is usually viral. However, if the adenoiditis is caused by a bacterial infection,
antibiotics may be prescribed for treatment. A steroidal nasal spray may also be prescribed in
order to reduce nasal congestion. Severe or recurring adenoiditis may require surgical removal of
the adenoids (adenotonsillectomy).

Signs and symptoms[edit]

Acute adenoiditis is characterized by fever, runny nose, nasal airway obstruction resulting in
predominantly oral breathing, snoring and sleep apnea, rhinorrhea with serous secretion in viral
forms and mucous-purulent secretion in bacterial forms. In cases due to viral infection symptoms
usually recede spontaneously after 48 hours, symptoms of bacterial adenoiditis typically persist
up to a week. Adenoiditis is sometimes accompanied by tonsillitis. Repeated adenoiditis may
lead to enlarged adenoids.
Complications[edit]

Complications of acute adenoiditis can occur due to extension of inflammation to the


neighboring organs.
Etiology[edit]

Viruses that may cause adenoiditis include adenovirus, rhinovirus and paramyxovirus. Bacterial
causes include Streptococcus pyogenes, Streptococcus pneumoniae, Moraxella catarrhalis and
various species of Staphylococcus including Staphylococcus aureus.
Diagnosis[edit]

Optical fiber endoscopy can confirm the diagnosis in case of doubt, directly visualizing the
inflamed adenoid.
Treatment[edit]

In cases of viral adenoiditis, treatment with analgesics or antipyretics is often sufficient. Bacterial
adenoiditis may be treated with antibiotics, such as amoxicillin - clavulanic acid or a
cephalosporin. In case of adenoid hypertrophy, adenoidectomy may be performed to remove the
adenoid.
Peritonsillar abscess (PTA), also known as a quinsy or quinsey, is a recognized complication of
tonsillitis and consists of a collection of pus beside the tonsil in what is referred to as Peritonsilar
space (Peri - meaning surrounding).

Unlike tonsillitis, which is more common in the pediatric age group, PTA has a more even age
spread from children to adults. Symptoms start appearing two to eight days before the
formation of an abscess. Progressively worsening, unilateral sore throat and pain during
swallowing usually are the earliest symptoms. As the abscess develops, persistent pain in the

peritonsillar area, fever, malaise, headache and a distortion of vowels informally known as "hot
potato voice" may appear. Neck pain associated with tender, swollen lymph nodes, referred ear
pain and halitosis are also common. While these signs may be present in tonsillitis itself, a PTA
should be specifically considered if there is limited ability to open the mouth (trismus). In short:

Severe unilateral pain in the throat;

Pyrexia above 103 degree F (39C);

Unilateral Earache;

Odynophagia and difficulty swallowing saliva;

Change in voice muffled voice, hot potato voice;

Intense salivation and dribbling,Thickened speech, Foetor oris, Halitosis;

Pain in the neck;

Malaise, Headache, Rigor.*

Trismus is common. Physical signs include redness and edema in the tonsillar area of the
affected side and swelling of the jugulodigastric lymph nodes. The uvula may be displaced
towards the unaffected side. Odynophagia (pain during swallowing), and ipsilateral earache also
can occur.

Causes[edit]
PTA usually arises as a complication of an untreated or partially treated episode of acute
tonsillitis. The infection, in these cases, spreads to the peritonsillar area (peritonsillitis). This
region comprises loose connective tissue and is hence susceptible to formation of abscess. PTA
can also occur de novo. Both aerobic and anaerobic bacteria can be causative. Commonly
involved species include streptococci, staphylococci and hemophilus.

Treatment[edit]
Treatment is surgical incision and drainage of the pus, thereby relieving the pain of the pressed
tissues. Antibiotics are also given to treat the infection. Internationally, the infection is frequently
penicillin resistant, so it is now common to treat with clindamycin.[1] Treatment can also be given
while a patient is under anesthesia, but this is usually reserved for children or anxious patients.

Complications[edit]

Retropharyngeal abscess;

Extension of abscess in other deep neck spaces leading to airway compromise. See
Ludwig's angina;

Septicaemia;

Possible necrosis of surrounding deep tissues;

In rare cases, mediastinitis.

Naming[edit]
The condition Peritonsillar Abscess is also referred to as "quincy", "quinsy" or "quinsey". These
terms are Anglicised versions of the French word esquinancie which was originally rendered as
Squinsey and subsequently Quinsy.[2]
Unlike tonsillitis, which is more common in the pediatric age group, PTA has a more even age
spread from children to adults. Symptoms start appearing two to eight days before the
formation of an abscess. Progressively worsening, unilateral sore throat and pain during
swallowing usually are the earliest symptoms. As the abscess develops, persistent pain in the
peritonsillar area, fever, malaise, headache and a distortion of vowels informally known as "hot
potato voice" may appear. Neck pain associated with tender, swollen lymph nodes, referred ear
pain and halitosis are also common. While these signs may be present in tonsillitis itself, a PTA
should be specifically considered if there is limited ability to open the mouth (trismus). In short:

Severe unilateral pain in the throat;

Pyrexia above 103 degree F (39C);

Unilateral Earache;

Odynophagia and difficulty swallowing saliva;

Change in voice muffled voice, hot potato voice;

Intense salivation and dribbling,Thickened speech, Foetor oris, Halitosis;

Pain in the neck;

Malaise, Headache, Rigor.*

Trismus is common. Physical signs include redness and edema in the tonsillar area of the
affected side and swelling of the jugulodigastric lymph nodes. The uvula may be displaced
towards the unaffected side. Odynophagia (pain during swallowing), and ipsilateral earache also
can occur.

Causes[edit]
PTA usually arises as a complication of an untreated or partially treated episode of acute
tonsillitis. The infection, in these cases, spreads to the peritonsillar area (peritonsillitis). This
region comprises loose connective tissue and is hence susceptible to formation of abscess. PTA
can also occur de novo. Both aerobic and anaerobic bacteria can be causative. Commonly
involved species include streptococci, staphylococci and hemophilus.

Treatment[edit]
Treatment is surgical incision and drainage of the pus, thereby relieving the pain of the pressed
tissues. Antibiotics are also given to treat the infection. Internationally, the infection is frequently
penicillin resistant, so it is now common to treat with clindamycin.[1] Treatment can also be given
while a patient is under anesthesia, but this is usually reserved for children or anxious patients.

Complications[edit]

Retropharyngeal abscess;

Extension of abscess in other deep neck spaces leading to airway compromise. See
Ludwig's angina;

Septicaemia;

Possible necrosis of surrounding deep tissues;

In rare cases, mediastinitis.

Naming[edit]
The condition Peritonsillar Abscess is also referred to as "quincy", "quinsy" or "quinsey". These
terms are Anglicised versions of the French word esquinancie which was originally rendered as
Squinsey and subsequently Quinsy.[2]
Cause[edit]

The causes of nosebleeds can generally be divided into two categories, local and systemic
factors, although a significant number of nosebleeds occur with no obvious cause.
Local factors[edit]

Blunt trauma (usually a sharp blow to the face such as a punch, sometimes
accompanying a nasal fracture)

Foreign bodies (such as fingers during nose-picking)

Inflammatory reaction (e.g. acute respiratory tract infections, chronic


sinusitis, rhinitis or environmental irritants)

Other possible factors[edit]

Anatomical deformities (e.g. septal spurs or Hereditary hemorrhagic


telangiectasia)

Insufflated drugs (particularly cocaine)

Intranasal tumors (e.g. Nasopharyngeal carcinoma or nasopharyngeal


angiofibroma)

Low relative humidity of inhaled air (particularly during cold winter seasons)

Nasal cannula O2 (tending to dry the olfactory mucosa)

Nasal sprays (particularly prolonged or improper use of nasal steroids)

Otic barotrauma (such as from descent in aircraft or ascent in scuba diving)

Consumption of tainted whey protein supplements that contain arsenic[2]

Surgery (e.g. septoplasty and Functional Endoscopic Sinus Surgery)

Systemic factors[edit]
Most common factors[edit]

Infectious diseases (e.g. common cold)

Hypertension

Other possible factors[edit]


This section does not cite any references or sources. Please help
improve this section by adding citations to reliable sources. Unsourced
material may be challenged and removed. (June 2013)

Drugs Aspirin, Fexofenadine/Allegra/Telfast, warfarin, ibuprofen,


clopidogrel, prasugrel, isotretinoin, desmopressin, ginseng and others

Alcohol (due to vasodilation)

Anemia

Liver diseases - Hepatic cirrhosis causes deficiency of factor II, VII, IX,& X

Connective tissue disease

Blood dyscrasias

Envenomation by mambas, taipans, kraits, and death adders

Heart failure (due to an increase in venous pressure)

Hematological malignancy

Idiopathic thrombocytopenic purpura

Pregnancy (rare, due to hypertension and hormonal changes)

Vascular disorders

Vitamin C and Vitamin K deficiency

von Willebrand's disease

Recurrent epistaxis is a feature of Hereditary Hemorrhagic Telangiectasia


(Osler-Weber-Rendu syndrome)

Mediastinal compression by tumours (raised venous pressure in

Pathophysiology[edit]

Nosebleeds are due to the rupture of a blood vessel within the richly perfused nasal mucosa.
Rupture may be spontaneous or initiated by trauma. Nosebleeds are reported in up to 60% of the
population with peak incidences in those under the age of ten and over the age of 50 and appear
to occur in males more than females.[3] An increase in blood pressure (e.g. due to general
hypertension) tends to increase the duration of spontaneous epistaxis.[4] Anticoagulant
medication and disorders of blood clotting can promote and prolong bleeding. Spontaneous
epistaxis is more common in the elderly as the nasal mucosa (lining) becomes dry and thin and
blood pressure tends to be higher. The elderly are also more prone to prolonged nose bleeds as
their blood vessels are less able to constrict and control the bleeding.
The vast majority of nose bleeds occur in the anterior (front) part of the nose from the nasal
septum. This area is richly endowed with blood vessels (Kiesselbach's plexus). This region is
also known as Little's area. Bleeding farther back in the nose is known as a posterior bleed and is
usually due to bleeding from Woodruff's plexus, a venous plexus situated in the posterior part of
inferior meatus.[5] Posterior bleeds are often prolonged and difficult to control. They can be
associated with bleeding from both nostrils and with a greater flow of blood into the mouth.[6]

Treatment[edit]

The flow of blood normally stops when the blood clots, which may be encouraged by direct
pressure applied by pinching the soft fleshy part of the nose. This applies pressure to Little's area
(Kiesselbach's area), the source of the majority of nose bleeds and promotes clotting. Pressure
should be firm and be applied for at least five minutes and up to 20 minutes; tilting the head
forward will help decrease the chance of nausea and airway obstruction.[3] Swallowing excess
blood can irritate the stomach and cause vomiting.
The local application of a vasoconstrictive agent has been shown to reduce the bleeding time in
benign cases of epistaxis. The drugs oxymetazoline or phenylephrine are widely available in
over-the-counter nasal sprays for the treatment of allergic rhinitis, and may be used for this
purpose.[7]
If these simple measures do not work then medical intervention may be needed to stop bleeding.
In the first instance this can take the form of chemical cautery of any bleeding vessels or packing
of the nose with ribbon gauze or an absorbent dressing (called anterior nasal packing). Such
procedures are best carried out by a medical professional. Chemical cauterisation is most
commonly conducted using local application of silver nitrate compound to any visible bleeding
vessel. This is a painful procedure and the nasal mucosa should be anaesthetised first, preferably
with the addition of topical adrenaline to further reduce bleeding. If bleeding is still uncontrolled
or no focal bleeding point is visible then the nasal cavity should be packed with a sterile
dressing, which by applying pressure to the nasal mucosa will tamponade the bleeding point.
Ongoing bleeding despite good nasal packing is a surgical emergency and can be treated by
endoscopic evaluation of the nasal cavity under general anaesthesia to identify an elusive
bleeding point or to directly ligate (tie off) the blood vessels supplying the nose. These blood
vessels include the sphenopalatine, anterior and posterior ethmoidal arteries. More rarely the
maxillary or a branch of the external carotid artery can be ligated. The bleeding can also be
stopped by intra-arterial embolization using a catheter placed in the groin and threaded up the
aorta to the bleeding vessel by an interventional radiologist. Continued bleeding may be an
indication of more serious underlying conditions.[8]
Other[edit]

The utility of local cooling of the head and neck is controversial.[9] Some state that applying ice
to the nose or forehead is not useful.[10][11] Others feel that it may promote vasoconstriction of the
nasal blood vessels and thus be useful.[12]
Prevention[edit]

Application of a topical antibiotic ointment to the nasal mucosa has been shown to be an
effective treatment for recurrent epistaxis.[13] One study found it to be as effective as nasal

cautery in the prevention of recurrent epistaxis in patients without active bleeding at the time of
treatment - both had a success rate of approximately 50 percent.[14]
Prognosis[edit]

Nosebleeds are rarely dangerous unless prolonged and heavy. However, in posterior bleeds, a
great deal of blood may be swallowed and therefore the amount of blood lost can be
underestimated. Recurrent nosebleeds may cause anemia due to iron deficiency.
Society and culture

Nasal Obstructions
A nasal obstruction is anything that impedes the flow of air into and out of the nose. The obstruction
may block one or both of the nasal passages.
Most cases of nasal obstruction are temporary, caused by sinusitis, allergies, birth control medication,
or overuse of nasal sprays. The blockage may also be caused by an anatomical factor, such as a
deviated septum, enlarged adenoids, nasal polyps, turbinate bones, or foreign objects.
If the nasal obstruction appears to coincide with a certain time of year, it may be caused by an
allergy, such as to pollen. If the blockage appears to be on only one side of the nose, then an
anatomical cause is more likely. Snoring is often a symptom of an anatomical cause for a nasal
obstruction.
Avoidance of an allergen, if the cause is allergic, can help alleviate symptoms. if the cause of the
obstruction is anatomical, surgery is usually required.

Nasal septum deviation is a common physical disorder of the nose, involving a displacement of
the nasal septum.

Contents
[hide]

1 Causes

2 Symptoms

3 Presentation

4 Treatment

5 Complications

6 See also

7 References

8 External links

Causes[edit]
It is most frequently caused by impact trauma, such as by a blow to the face.[1] It can also be a
congenital disorder, caused by compression of the nose during childbirth.[1] Deviated septum is
associated with genetic connective tissue disorders such as Marfan syndrome, Homocystinuria[2]
and EhlersDanlos syndrome.[3]

Symptoms[edit]
Symptoms of a deviated septum include infections of the sinus and sleep apnea, snoring,
repetitive sneezing, facial pain, nosebleeds, difficulty with breathing,[4] and mild to severe loss of
the ability to smell.[5]

Presentation[edit]
The nasal septum is the bone and cartilage in the nose that separates the nasal cavity into the two
nostrils. The cartilage is called the quadrangular cartilage and the bones comprising the septum
include the maxillary crest, vomer and the perpendicular plate of the ethmoid. Normally, the
septum lies centrally, and thus the nasal passages are symmetrical.[6] A deviated septum is an
abnormal condition in which the top of the cartilaginous ridge leans to the left or the right,
causing obstruction of the affected nasal passage. The condition can result in poor drainage of
the sinuses. Patients can also complain of difficulty breathing, headaches, bloody noses, or of
sleeping disorders such as snoring or sleep apnea.[6]
It is common for nasal septa to depart from the exact centerline; the septum is only considered
deviated if the shift is substantial or is adversely affecting the patient.[1] Many people with a
deviation are unaware they have it until some pain is produced. By itself, a deviated septum can
go undetected for years and thus be without any need for correction.[1]
Some people are concerned about diminished airflow through the effectively smaller nostril
resulting from deviation[citation needed].

Treatment[edit]
In mild cases, symptoms can simply be treated with medications such as decongestants,
antihistamines, and nasal spray. Medication temporarily relieves symptoms, but does not correct
the underlying condition.[7] A cure to symptoms related to septal deviations is available in the
form of a minor surgical procedure known as a septoplasty. The surgery is performed quickly
(lasts roughly 1 hour) and does not result in any cosmetic alteration or external scars. Recovery
from the procedure may take anywhere from 2 days to 4 weeks to heal completely.[8] Septal
bones never regrow. However, if symptoms reappear they are not related to deviations.
Reappearance of symptoms may be due to mucosal metaplasia of the nose.[9]

Complications[edit]
1. Nasal septum perforation : Due to bilateral trauma of the mucoperichondrial flaps opposite
each other.
2. Septal haematoma and septal abscess.
3. Adhesions and synachiae: between septal mucosa and lateral nasal wall.
4. Saddle nose: Due to over resection of the dorsal wall of the septal cartilage.
5. Dropped nasal tip: Due to resection of the caudal margin.
From Medical Wiki - MedMantic
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Contents
[hide]

1 What is Laryngeal Obstruction

2 Symptoms of Laryngeal Obstruction

3 What Causes Laryngeal Obstruction

4 Tests and Diagnosis for Laryngeal Obstruction

5 Treatments of Laryngeal Obstruction

What is Laryngeal Obstruction

Laryngeal obstruction (laryngeal obstruction), also known as laryngeal obstruction, the


obstruction in the throat and cause breathing difficulties due to the throat or in the vicinity of
tissue lesions, a common clinical symptoms, acute and chronic of the other. The acute, Chinese
medicine called acute laryngeal wind. Without timely treatment, can be choked to death. Smaller
child care larynx, submucosal loose tissue, throat airflow pathway bending the throat the nerve
susceptible stimulation caused spasm, it is more susceptible to laryngeal obstruction. Common
cause of acute inflammatory lesions of the larynx, laryngeal trauma, laryngeal edema,
laryngospasm, laryngeal tumors, congenital laryngeal deformity, vocal cord paralysis.

Symptoms of Laryngeal Obstruction


The symptoms of laryngeal obstruction:
Inspiratory dyspnea
The main features of laryngeal obstruction. Glottis narrow throat, formed by both sides of the
vocal cords edge slightly upward tilt. Under normal circumstances, the inspiratory airflow to the
vocal cords slant downward, inward push, but accompanied by vocal cord abduction the glottis
split; therefore unobstructed breathing. Lesions, laryngeal mucosa congestion and swelling, so
glottis narrowing, airflow inspiration vocal cords slant downward, inward pressure the narrowed
glottis becomes narrow, resulting in inspiratory dyspnea. Its performance to strengthen
inspiratory movement, time, inhale deep and slow, but does not increase the ventilation, such as
non-significant hypoxia, respiratory rate unchanged. The expiratory airflow upward impulse to
open the vocal cords, glottis than inspiratory large, are still capable of exhaled air, it is breath
difficulties are not significant.
Inspiratory laryngeal Ming
The inspiratory airflow sucked, squeezed through the narrow glottis crack formation of the
airflow vortex counterattack vocal cords, vocal cords vibrate issued a sharp throat song.
Laryngeal obstruction light, light jets song; severe, throat song very loud, audible compartment.
Exhale glottis crack, it does not sound.
Inspiratory phase soft tissue depression
Inhale air is not easy to enter the lungs through the glottis, chest and abdomen auxiliary
respiratory muscles compensatory increase physical activity to help breathing, chest expansion,
but the lobe can not to expansion, so the increased negative intrathoracic pressure to the chest
wall its surrounding soft tissue inhalation is suprasternal fossa, supraclavicular fossa the sternum
xiphoid or upper abdomen, the inspiratory depression of the intercostal space, known as the four
depressions sign. The degree of depression often varies with the degree of dyspnea, weak muscle
tone of the children, the more obvious signs of the depression.
4 hoarseness
Lesions on the vocal cords. Often hoarseness, or aphonia.

5. Cyanosis
Pale purple from lack of oxygen, head thrown back, rapid pulse, face anxiety, irritability is the
throat obstruction white spoon advanced symptoms. Check according to the severity of laryngeal
obstruction is divided into four degrees. Once. Quiet without dyspnea. Activity or crying, mild
inspiratory dyspnea, slightly inspiratory laryngeal Ming and mild inspiratory thoracic soft tissue
around the depression. Second. Mild inspiratory dyspnea quiet, the suction throat Ming and
inspiratory thoracic soft tissue around the depression, increased activity, but does not affect sleep
and eat, no irritability and other symptoms of hypoxia. The pulse is still normal. Three degrees.
The obvious inspiratory dyspnea, throat song very loud, suprasternal fossa, supraclavicular fossa,
the inspiratory phase of the soft tissue of the upper abdominal, intercostal, etc. sag significantly.
Symptoms of irritability, difficulty falling asleep, do not want to eat, pulse rate and oxygen. Four
degrees. Breathing extremely difficult. Due to severe hypoxia and carbon dioxide increased, the
patient restless tamper with hand, foot, cold sweats, pale or cyanosis, disorientation, irregular
heartbeat, thready and weak pulse, blood pressure drops. Incontinence. If not rescued due to
choking, coma and heart failure and death.

What Causes Laryngeal Obstruction


Laryngeal obstruction etiology:
Children with acute laryngeal obstruction
(1) congenital laryngeal malformations.
(2) acute inflammation: such as children with acute laryngitis, acute epiglottitis, acute
laryngotracheal bronchitis, throat diphtheria, throat abscess, retropharyngeal abscess, floor of the
mouth, cellulitis, etc..
(3) laryngeal foreign body. Foreign body larynx, airway foreign bodies not only caused by
mechanical obstruction, can also cause laryngospasm.
(4) laryngeal trauma or tracheal bronchoscopy trauma.
(5) laryngospasm: such as rickets, low blood calcium, adenoidal hypertrophy.
Children with chronic laryngeal obstruction
(1) laryngostenosis.
(2) of the laryngeal tumors. Tumor laryngeal cancer, multiple laryngeal papilloma, hypopharynx
tumors, thyroid tumors.
(3) throat rickets.
(4) The thymus hypertrophy, aortic arch deformity oppression.

(5) heart and kidney and other chronic diseases caused by laryngeal edema.
(6) deformity. Congenital laryngeal stridor, laryngeal webs, laryngeal cartilage deformity
cicatricial stenosis throat.
3 adult acute laryngeal obstruction
(1) edema angioneurotic edema, drug allergies and heart and kidney diseases.
(2) Acute epiglottitis throat abscess.
(3) laryngeal trauma.
(4) laryngeal the incarcerated foreign matter.
4 adult chronic laryngeal obstruction
(1) of the laryngeal tumors.
(2) laryngostenosis.
(3) bilateral recurrent laryngeal nerve paralysis.
(4) vocal cord paralysis caused by a variety of reasons on both sides of the vocal cord paralysis.

Tests and Diagnosis for Laryngeal Obstruction


Throat blocking the diagnosis:
1 cause the exact cause of laryngeal obstruction and a history.
Inspiratory dyspnea: inspiratory than the expiratory phase laborious and prolonged, may be
associated with different degrees of soft tissue depression.
Inspiratory throat tingle.
4. Hoarseness.
According to the severity of the laryngeal obstruction divided into 4 degrees.
Once: quiet breathing difficulties. Activity or crying mild inspiratory dyspnea, slightly
inspiratory laryngeal stridor and the inspiratory thoracic soft tissue around the depression.
Second degree: mild dyspnea and inspiratory laryngeal stridor and inspiratory thoracic soft tissue
around the depression, increased activity, but does not affect sleep and eat, no irritability and
other symptoms of hypoxia. The pulse is still normal.

Three degrees: the obvious difficulty in breathing, throat wheezing louder the inspiratory
thoracic soft tissue around the sunken significant, and the emergence of symptoms of hypoxia,
such as irritability, difficulty falling asleep, do not want to eat, pulse quicken.
Four: the extreme difficulty breathing. The patient restless tamper with hand, foot, cold sweats,
pale or cyanosis, disorientation, irregular heartbeat, pulse breakdown, coma, incontinence.
Without timely rescue breathing may be due to suffocation resulting cardiac arrest and death.
According to history, signs and symptoms, diagnosis of laryngeal obstruction is not difficult, but
the main thing is clear cause. , Then check to clear cause serious breathing difficulties, should lift
its first breathing difficulties.
Differential diagnosis:
With bronchial asthma, tracheobronchitis caused breath, mixed dyspnea, phase identification.
1. Pneumonia
High fever, tachypnea, nasal flap, lead to a diagnosis of lung auscultation, X-ray photographs.
2. Bronchial asthma
History of repeated attacks, mainly expiratory dyspnea expiratory period of time longer than the
inspiratory phase, three depressions sign, lungs wheeze.

Treatments of Laryngeal Obstruction


Treatment of laryngeal blocking:
Principles and methods of treatment should be determined according to the cause, symptoms and
the degree of dyspnea. Less severe breathing difficulties, mainly due to treatment to go,
otherwise to ensure airway, rescue treatment of life-based.
1 cause of treatment
(1) due to foreign bodies, as soon as possible to remove the foreign body.
(2) due to allergy or angioneurotic edema, to treat laryngeal edema.
(3) due to inflammation, the application of sufficient quantities of antibiotics, and give local
treatment.
(4) for emergency patients, the cause of treatment should be in the trachea incision further.
(5) due to other causes, the treatment should be appropriate cause. While oxygen, artificial
respiration, injection coramine, caffeine and other cardiac drugs.

2. Treatment principles
I: a clear cause, actively cause of treatment. Caused by inflammation, use sufficient quantities of
antibiotics and corticosteroids.
degree: a result of inflammation caused by, with a sufficient amount of effective antibiotics
and glucocorticoids, mostly to avoid tracheotomy. Foreign body should be quickly taken in
addition; such as throat cancer, laryngeal trauma, bilateral vocal cord paralysis is not able to
remove the cause, should consider doing a tracheotomy.
: caused by the inflammation of the throat blocking time shorter under close observation
aggressive use of drug therapy, and ready to tracheotomy. If drug therapy is still in the doldrums,
poor general condition, should Early tracheotomy. For cancer, you should immediately
tracheotomy.
: Now tracheotomy. If the condition is very urgent, you can first thyrocricotomy surgery or
intubation first, and then tracheotomy.

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