Clinical Picture
🔹
Three Stages :
Initial stage :
short time of coughing , dyspnea and cyanosis
F.B may be coughed out or may be lodge in the larynx or further down to
🔹
trachea and bronchi
Latent stage:
Period with no symptoms , it may last a few hours or a few weeks
according the size and nature of the F.B
The respiratory mucosa adapts to the presence of F.B and initial
🔹
symptoms was disappear .
Manifest stage:
Types of F.B : F.B in bronchus causing :
🔹
1- Exogenous F.B :
🔹 vegetable : watermelon seed , beans , wheat seed , peas
non vegetable : beads , plastic toies pins , ….
1- Complete obstruction lead to lung collapse
-Dullness on percussion
2- Endogenous F.B : -Shift of mediastinum to same side
vomitus
-No air entry on auscultation
blood
Children : more common 2- Partial obstruction lead to emphysema
🔷
Adult : rare ( mental retard , coma , convulsion , alcoholic intoxication) -Hyperresonance on percussion
Site : larynx – trachea - bronchi
🔹 Larynx : rare
-if complete obs. Leading to death
-Shift of mediastinum to opposite side
-Diminished air entry
Causes of Hoarseness:
🔹
1- Congenital : web or cyst -Partial obs. Stridor , wheeze , cough , resp. difficulty
🔹
2- Inflammatory : acute or chronic Trachea : choking , stridor , wheez , cough , palpatory thud
3- Neoplastic : Bronchi : cough , wheeze , diminish air entry to lung , respiratory
Benign : polyps , papillomas distress
Investigations:
▪️
malignant : laryngeal cancer Lung collapse , emphysema , pneumonitis , bronchiectasis , lung abscess
4- Traumatic : blunt , stab and surgical Right bronchus more common than left X-Ray
5- Paralysis : Unilateral or bilateral Broncoscopy
6-Miscellaneous : allergies , GERD , nodules , Treatment :
granuloma Removal of F.B :
Heimlich manoeuvre
Back blows manoeuvre
Bronchoscopy
Hoarseness
Rough quality , low – pitched voice due to one or
more of 3 factors :
1- Impairment of VC adduction Foreign Bodies in
2- Impairment of VC tension
3- Impairment of VC vibration ( mobility ) the Aerodiagestive passage
Hoarseness of voice more than
2 weeks should be assessed by
laryngoscopy 🔹
Anatomy of esophagus
Esophagus : muscular tube extend from lower border of pharynx ( at
Paralysis :
Unilateral or bilateral 🔹
lower border of C6 ) to the cardia of the stomach ( at level of T12 )
Length : 24 cm
Distance from upper incisors to the cardia 40 cm
Causes :
1- Idiopathic Distance from upper incisors to the first physiological constriction 15 cm
2- Surgical Distance from upper incisors to the 2nd physiological constriction 25 cm
3- neoplasia Distance from upper incisors to the 3rd physiological constriction 40 cm
🔷Foreign Body in esophagus Physiological Constrictions
More common than laryngeal and bronchial F.B
Most commonly :
1- children
2- mental retard
🔹 Predisposing Factors
-Dental factors : old age ( natural or artificial )
3- old age
🔹
-Esophageal factors : narrowing like CA
Causes of Stridor Tybes of F.B : Clinical Feature :
Congenital : 1- coin Dysphagia , chocking , gagging .
Laryngomalacia Stridor is noisy breathing due to obstruction 2- chicken bone Drooling of saliva
Congenital web
Congenital cyst
Congenital sub glottis stenosis
🔹
TYPES :
Inspiratory : obstruction from larynx and
3- fish bone
4- meat
( children .. Gangging )
( infants .. Irritable and refuse to eat )
Congenital subglottis
haemangioma
🔹
pharynx ( Supraglottis )
Expiratory : obstruction in bronchial and low Stridor 5- others methallic and plastic objects
Congenital vocal cord paralysis 🔹
trachea ( Subglottis )
Biphasic : obstruction at the level of cervical
Laryngeal symptoms can be important indicators of
underlying conditions and help :
Inflammatory :
trachea ( Glottis ) . Identify underlying conditons
. Prevent complication larynx 🔹 Investigation :
🔹
Acute specific : diphtheria
🔹
X ray
Chronic specific : granuloma Laryngeal Symptoms Treatment : removal of F.B
Acute non specific :
🔹
Hoarseness byEsophagoscopy under G/A
Acute laryngitis Stridor
Laryngeal Symptoms Complication:
Acute epiglottitis Dyspnea 1- Perforation tear
Croup Pain 2- Mediastinitis
Traumatic : Cough 3- Bleeding
Surgical Dysphagia 4- Infection
High tracheostomy Expectoration
ETI
Endoscopy
Accidental
Acute inflammation of laryngeal mucosa
Gun shot
It usually associated with upper respiratory
Stab
tract infection
Blow
Start by viral infection and then secondary
FB
bacterial infection
Car accident
Neoplastic :
Benign : multible papillomatosis 🔶
🔸CAUSES OF ACUTE LARYNGITIS
Infectious type :
Malignant : CA larynx
Viral infection (most common )
Miscellaneous :
Bilateral vocal cord paralysis 🔸Non
Bacterial infection (SP , H.Inf , St.A)
infectious type :
Vocal Strain ( vocal abuse )
Laryngeal oedema
Foreign Bodies
Inhalation of hot gases
Causes : Inhalation of chemicals
GERD : Gastroesophageal Reflex Disease
Bacterial infections : TB
Viral infections : Herpes Simplex
🔹 Clinical Manifestations
-Hoarseness
Vocal strain PAIN ACUTE LARYNGITIS -Cough
Trauma -Pain
Laryngeal CA
Radiation therapy 🔹
-fever
Physical examination
Mirror laryngoscopy
Direct laryngoscopy ( lens 70 - 90 D )
Causes : Flexible Fiberoptic laryngoscopy
Laryngitis Vocal cord look red and their edges are
Laryngeal edema rounded rather than sharp
Vocal cord paralaysis Hyperemia of the entire larynx and the
laryngeal neoplastic Laryngeal symptoms (DYSPNEA)
arytenoids may be swollen
Laryngomalacia
Trauma
Foreign Body
🔸
TREATMENT
🔸 Most of the patient not required specific treatment
🔶 Voice rest \ stop smoking or alcohole \ PPI
But some patients who have fever , persistent
🔸
cough or strider required treatment :
Antibiotic \ steam inhalation and voice rest
Patients with severe acute laryngitis may require
Hospitalization
Defination causes Clinical pictures signs investigation TREATMENT
1-Tripod sign
2-Tachycardia in adult
3-By indirect laryngoscopy the epiglottitis 1- Lareal soft tissue
found Cherry Red and Swollen. X-Ray of neck :
4- Droolling of salivan Thumb sign
Symptoms : Hospitalization and 5S
It is acute inflammatory condition of the supraglottic It is usually associated with upper respiratory There is usually a short history with rapid 1- Saving the air way
structure : infection progression 2- Supplaying Oxygen inhalation
Acute epiglottitis Epiglottic( mainly ) Organism : by Haemophilus Influenza tybe B
Common in children ( 2-8 years )
Start with URTI -Fever- Sore throat- 3- Steam inhlation
4- Steroids : to decrease oedema
Ary-epiglottic fold Dysphagia and Odynophagia
But can also effected in adult Dyspnea -Stridor(inspiratory)-Hoarseness(HOT 5- Systemic antibiotic
Arytenoid
patato muffled voice )
epiglottis
by fatema okoff
Aetiology X-Ray AP View
Origanism : Para Influenza Type I and Type II
Acute Inflammation of the Larynx ,Trachea and Bronchi
Adult : the cause ( H. Simplex , Cytomegalovirus
, Influenza virus )
🔹 Upper respiratory symptoms ( gradual in
onset )
( steeple sign )
Hospitalization and 5S
1- Saving the air way ( ETI or Tracheostoy )
2- Supplaying Oxygen inhalation
-Fever
laryngotracheobronchitis Most common infectious cause of airway obstruction in
children ( 3 months to 3 years ) pathology -Painfull croupy cough ( barking cough ) Suprasternal and Supracostal resession 3- Steam inhlation ( Humidification )
4- Steroids : to decrease oedema
croup More common than acute epiglottits Mucosal swelling in subglottic area lead to
subglottic oedema
-Hoarseness and Strider
5- Systemic antibiotic for secondary infection
-Initially inspiratory then Biphasic
Production of thick tenacious mucus which can
hardly be expectorated
Pseudomembrane formation
🔹
Three Stages :
Initial stage :
short time of coughing , dyspnea and cyanosis
F.B may be coughed out or may be lodge in the larynx or further down to
🔹
trachea and bronchi
Latent stage:
Period with no symptoms , it may last a few hours or a few weeks
according the size and nature of the F.B
The respiratory mucosa adapts to the presence of F.B and initial
🔹
symptoms was disappear .
Manifest stage:
Types of F.B : F.B in bronchus causing :
🔹
1- Exogenous F.B :
🔹 vegetable : watermelon seed , beans , wheat seed , peas
non vegetable : beads , plastic toies pins , ….
1- Complete obstruction lead to lung collapse
-Dullness on percussion
2- Endogenous F.B : -Shift of mediastinum to same side
vomitus
-No air entry on auscultation
blood
Children : more common 2- Partial obstruction lead to emphysema
🔷
Adult : rare ( mental retard , coma , convulsion , alcoholic intoxication) -Hyperresonance on percussion
Site : larynx – trachea - bronchi
🔹 Larynx : rare
-if complete obs. Leading to death
-Shift of mediastinum to opposite side
-Diminished air entry
Causes of Hoarseness:
🔹
1- Congenital : web or cyst -Partial obs. Stridor , wheeze , cough , resp. difficulty
🔹
2- Inflammatory : acute or chronic Trachea : choking , stridor , wheez , cough , palpatory thud
3- Neoplastic : Bronchi : cough , wheeze , diminish air entry to lung , respiratory
Benign : polyps , papillomas distress
Investigations:
▪️
malignant : laryngeal cancer Lung collapse , emphysema , pneumonitis , bronchiectasis , lung abscess
4- Traumatic : blunt , stab and surgical Right bronchus more common than left X-Ray
5- Paralysis : Unilateral or bilateral Broncoscopy
6-Miscellaneous : allergies , GERD , nodules , Treatment :
granuloma Removal of F.B :
Heimlich manoeuvre
Back blows manoeuvre
Bronchoscopy
Hoarseness
Rough quality , low – pitched voice due to one or
more of 3 factors :
1- Impairment of VC adduction Foreign Bodies in
2- Impairment of VC tension
3- Impairment of VC vibration ( mobility ) the Aerodiagestive passage
Hoarseness of voice more than
2 weeks should be assessed by
laryngoscopy 🔹
Anatomy of esophagus
Esophagus : muscular tube extend from lower border of pharynx ( at
Paralysis :
Unilateral or bilateral 🔹
lower border of C6 ) to the cardia of the stomach ( at level of T12 )
Length : 24 cm
Distance from upper incisors to the cardia 40 cm
Causes :
1- Idiopathic Distance from upper incisors to the first physiological constriction 15 cm
2- Surgical Distance from upper incisors to the 2nd physiological constriction 25 cm
3- neoplasia Distance from upper incisors to the 3rd physiological constriction 40 cm
🔷Foreign Body in esophagus Physiological Constrictions
More common than laryngeal and bronchial F.B
Most commonly :
1- children
2- mental retard
🔹 Predisposing Factors
-Dental factors : old age ( natural or artificial )
3- old age
🔹
-Esophageal factors : narrowing like CA
Causes of Stridor Tybes of F.B : Clinical Feature :
Congenital : 1- coin Dysphagia , chocking , gagging .
Laryngomalacia Stridor is noisy breathing due to obstruction 2- chicken bone Drooling of saliva
Congenital web
Congenital cyst
Congenital sub glottis stenosis
🔹
TYPES :
Inspiratory : obstruction from larynx and
3- fish bone
4- meat
( children .. Gangging )
( infants .. Irritable and refuse to eat )
Congenital subglottis
haemangioma
🔹
pharynx ( Supraglottis )
Expiratory : obstruction in bronchial and low Stridor 5- others methallic and plastic objects
Congenital vocal cord paralysis 🔹
trachea ( Subglottis )
Biphasic : obstruction at the level of cervical
Laryngeal symptoms can be important indicators of
underlying conditions and help :
Inflammatory :
trachea ( Glottis ) . Identify underlying conditons
. Prevent complication larynx 🔹 Investigation :
🔹
Acute specific : diphtheria
🔹
X ray
Chronic specific : granuloma Laryngeal Symptoms Treatment : removal of F.B
Acute non specific :
🔹
Hoarseness byEsophagoscopy under G/A
Acute laryngitis Stridor
Laryngeal Symptoms Complication:
Acute epiglottitis Dyspnea 1- Perforation tear
Croup Pain 2- Mediastinitis
Traumatic : Cough 3- Bleeding
Surgical Dysphagia 4- Infection
High tracheostomy Expectoration
ETI
Endoscopy
Accidental
Acute inflammation of laryngeal mucosa
Gun shot
It usually associated with upper respiratory
Stab
tract infection
Blow
Start by viral infection and then secondary
FB
bacterial infection
Car accident
Neoplastic :
Benign : multible papillomatosis 🔶
🔸CAUSES OF ACUTE LARYNGITIS
Infectious type :
Malignant : CA larynx
Viral infection (most common )
Miscellaneous :
Bilateral vocal cord paralysis 🔸Non
Bacterial infection (SP , H.Inf , St.A)
infectious type :
Vocal Strain ( vocal abuse )
Laryngeal oedema
Foreign Bodies
Inhalation of hot gases
Causes : Inhalation of chemicals
GERD : Gastroesophageal Reflex Disease
Bacterial infections : TB
Viral infections : Herpes Simplex
🔹 Clinical Manifestations
-Hoarseness
Vocal strain PAIN ACUTE LARYNGITIS -Cough
Trauma -Pain
Laryngeal CA
Radiation therapy 🔹
-fever
Physical examination
Mirror laryngoscopy
Direct laryngoscopy ( lens 70 - 90 D )
Causes : Flexible Fiberoptic laryngoscopy
Laryngitis Vocal cord look red and their edges are
Laryngeal edema rounded rather than sharp
Vocal cord paralaysis Hyperemia of the entire larynx and the
laryngeal neoplastic Laryngeal symptoms (DYSPNEA)
arytenoids may be swollen
Laryngomalacia
Trauma
Foreign Body
🔸
TREATMENT
🔸 Most of the patient not required specific treatment
🔶 Voice rest \ stop smoking or alcohole \ PPI
But some patients who have fever , persistent
🔸
cough or strider required treatment :
Antibiotic \ steam inhalation and voice rest
Patients with severe acute laryngitis may require
Hospitalization
Defination causes Clinical pictures signs investigation TREATMENT
1-Tripod sign
2-Tachycardia in adult
3-By indirect laryngoscopy the epiglottitis 1- Lareal soft tissue
found Cherry Red and Swollen. X-Ray of neck :
4- Droolling of salivan Thumb sign
Symptoms : Hospitalization and 5S
It is acute inflammatory condition of the supraglottic It is usually associated with upper respiratory There is usually a short history with rapid 1- Saving the air way
structure : infection progression 2- Supplaying Oxygen inhalation
Acute epiglottitis Epiglottic( mainly ) Organism : by Haemophilus Influenza tybe B
Common in children ( 2-8 years )
Start with URTI -Fever- Sore throat- 3- Steam inhlation
4- Steroids : to decrease oedema
Ary-epiglottic fold Dysphagia and Odynophagia
But can also effected in adult Dyspnea -Stridor(inspiratory)-Hoarseness(HOT 5- Systemic antibiotic
Arytenoid
patato muffled voice )
epiglottis
by fatema okoff
Aetiology X-Ray AP View
Origanism : Para Influenza Type I and Type II
Acute Inflammation of the Larynx ,Trachea and Bronchi
Adult : the cause ( H. Simplex , Cytomegalovirus
, Influenza virus )
🔹 Upper respiratory symptoms ( gradual in
onset )
( steeple sign )
Hospitalization and 5S
1- Saving the air way ( ETI or Tracheostoy )
2- Supplaying Oxygen inhalation
-Fever
laryngotracheobronchitis Most common infectious cause of airway obstruction in
children ( 3 months to 3 years ) pathology -Painfull croupy cough ( barking cough ) Suprasternal and Supracostal resession 3- Steam inhlation ( Humidification )
4- Steroids : to decrease oedema
croup More common than acute epiglottits Mucosal swelling in subglottic area lead to
subglottic oedema
-Hoarseness and Strider
5- Systemic antibiotic for secondary infection
-Initially inspiratory then Biphasic
Production of thick tenacious mucus which can
hardly be expectorated
Pseudomembrane formation
