Management of upper airway problems

The upper airway includes the nose and nasal passage, paranasal sinuses, pharynx (nasopharynx, oropharynx and hypopharynx), larynx and trachea. The airway is lined with a mucus membrane that secrete mucus, that traps or collects particles and germs. The mucus layer is constantly moved by little hair cells (cilia) to the esophagus, to be swallowed.

Snoring and sleep apnea

Sleep apnea is a disorder in which breathing during sleep is repeatedly interrupted. The breathing stops and starts throughout the sleep period.

Besides the snoring sound, people wake up feeling tired.

Personality changes, morning headache, daytime sleepiness and irritability are frequent symptoms.

Different types of sleep apnea are:

Obstructive – the airway blocks due to relaxation of the palatal, pharyngeal and tongue muscles. As the affected person falls asleep, the muscles relax and blocks the airway. After a while the brain picks up the decrease in blood oxygen levels, and the sleep depth drops with an increase in muscle tone, improving the airway. Then the cycle repeats. Thus, normal sleep cycles are absent.

Central – the brain does not send normal signals to breathing muscles.

Combination – mixture of central and obstructive sleep apnea.

Evaluation includes an upper airway evaluation and sleep study (polysomnogram). Scans of the upper airway and brain may be included.

Treatment varies from lifestyle changes (losing weight, stopping smoking), oral appliances or a CPAP (Constant Positive Airway Pressure) device.

Surgery can be an option. This includes opening of a blocked nasal passage, throat and tongue base surgery to improve the pharyngeal airway. Pulling the tongue forward or even a tracheotomy (in selected cases) may be considered.

Laryngeal papillomatosis

This is a rare condition caused by the Human papilloma virus (HPV).

Papillomas (benign tumors or warts) form in the upper aerodigestive tract. This leads to vocal cord changes and associated hoarseness. If the growth is excessive, airway obstruction (stridor) develops. As the papillomas increase in size, breathing becomes more and more difficult. This is a medical emergency.

Surgical removal via endoscopy remains the main treatment option. Unfortunately, the papillomas tend to recur, leading to repeated surgical debulking procedures.

Medical treatment, to decrease the frequency (or even stop) surgical procedures is also used. 

Laryngeal and tracheal stenosis

Narrowing of the larynx and trachea lead to airway obstruction.

This may be caused by birth abnormalities, certain diseases (infections or inflammatory), tumors, trauma (intubation, surgical, mechanical) or chemicals (corrosive inhalation/ swallowing, gastroesophageal reflux).

Evaluation of the larynx and trachea by endoscopy and CT scans to determine the extent and position of the stenosis.

Treatment varies from dilatation, CO2 laser or external techniques (resection or reconstruction) with or without stents. Sometimes a temporary tracheotomy is needed.

Medical conditions like gastroesophageal reflux disease and autoimmune disease needs to be treated, to prevent recurrence and help with the success of the procedures.

Laryngotracheomalacia

 This is a condition with weakness of the laryngeal and/or tracheal framework, resulting in a floppy larynx and/or trachea. During inspiration, the negative airway pressure sucks the floppy larynx and/or trachea inwards, with obstruction of the airway.

This one of the most common causes of congenital stridor. It is usually self-limiting as the framework gets stronger with age. By the age of six months most cases have cleared up. It is seldom necessary for surgical intervention.

In older patients’ weakness of the framework can develop due to pressure (blood vessel, tumors e.g. thyroid tumors), medical conditions (autoimmune disease), prolonged intubation or syndromes (Marfan etc.).

Surgery is aimed at strengthening/ support of the laryngotracheal framework.