Wheezes: “All that wheezes is not asthma, but all that wheezes is obstruction.”

Extrathoracic Upper Airway

Nasopharynx & Oropharynx

• Tonsillar Hypertrophy
• Pharyngitis
• Peritonsillar abscess
• Retropharyngeal abscess

Larynogpharynx & Larynx

• Epiglottis
• Paradoxical Vocal Cord Movement
• Vocal Cord Paralysis
• Anaphylaxis & Laryngeal Edema
• Post Nasal Drip
• Benign/Malignant Tumors
• Relapsing Polychondritis (subglottic stenosis)

Intrathoracic Upper/Lower Airways

Trachea

• Tracheal stenosis
• Tracheomalacia
• Goiter

Proximal Airways

• Foreign-body aspiration
• Bronchitis

Distal Airways

• Asthma
• COPD
• Pulmonary edema
• Bronchiectasis

“Thumb sign” of epiglottitis

Infectious causes of epiglottitits

Bacterial:

• H. influenza (type B)
• Steptococcus pneumoniae
• Staphylococcus aureus (MRSA/MSSA)
• B-hemolytic streptoccoci (A-G)

Viral:

• HSV
• VZV
• EBV
• Para/Influenza

Non-Infectious

• Thermal injury
• Foreign body

Risk Factors:

Children: incomplete/lack of immunizations; immune deficiency

Adults: comorbid condition (HTN, DM, PSA, etc.), immune deficiency

3 D’s of Epiglottitis – Drooling, Dysphagia, Distress

Presentation:

Children: respiratory distress, anxiety, posture (see below), stridor, muffled (hot potato) voice.

Tripod Posture / Sniffling Position:

Adults: sore throat/odynophagia (~90%), fever, muffled voice, drooling, stridor/respiratory distress, hoarseness

Onset:

Children: <24 hours (frequently <12 hours)

Adults: 48 hours (65%)

Treatment:

First – secure airway!

Next – empiric antibiotics (typically 3rd generation cephalosporin and MRSA coverage)