Obstructive Lung Disease

Upper Airway Obstruction

Bilateral Vocal Fold Immobility (BVFI) (see Bilateral Vocal Fold Immobility)

Cricoarytenoid Arthritis (see Cricoarytenoid Arthritis)

  • Primary Rheumatologic Disease
  • Other
    • Cricoarytenoid Joint Ankylosis Due to Prior Streptococcal Infection (see Streptococcus)
    • Crohn’s Disease (see Crohn’s Disease)
    • External Trauma to Cricoarytenoid Joint
    • Internal Trauma Due to Endotracheal Tube-Related Injury to Cricoarytenoid Joint: includes posterior or anterior arytenoid displacement, posterior dislocation resulting from extubation with a partially inflated endotracheal tube cuff, arytenoid chondritis secondary to prolonged endotracheal intubation
    • Mumps-Associated Laryngeal Arthritis (see Mumps Virus)
    • Radiation Therapy Injury to Cricoarytenoid Joint (see Radiation Therapy)
    • Tietze’s Syndrome

Laryngeal Inflammation

Laryngospasm (see Laryngospasm)

Neurologic Disease/Dysfunction Involving the Vocal Folds

  • Alport Syndrome (see Alport Syndrome): case report invoved a patient with chronic kidney disease, post-op from surgery with high amount of blood loss and possible impaired perfusion to recurrent laryngeal nerves (with ischemic injury) during the case
  • Altered Mental Status with Inability to Protect Upper Airway
    • Physiology
      • Airway Obstruction Occurs Due to Tongue Prolapse into the Posterior Pharynx and/or Decreased Soft Palate Muscular Tone (Anaesth Intensive Care, 1994) [MEDLINE] (Anesthesiology, 1996) [MEDLINE]
    • Clinical: typically acute
  • Amyotrophic Lateral Sclerosis (ALS) (see Amyotrophic Lateral Sclerosis)
  • Arnold-Chiari Malformation
  • Charcot-Marie-Tooth Disease
  • Creutzfeldt-Jakob Disease (CJD) (see Creutzfeldt-Jakob Disease)
  • Diabetes Mellitus (DM) (see Diabetes Mellitus)
    • Physiology: neuropathy involving the laryngeal nerves
  • Dystonic Reaction of Pharyngeal and Laryngeal Muscles (see Dystonic Reaction of Pharyngeal+Laryngeal Muscles): typically acute
  • Essential Tremor (see Essential Tremor): typically mild upper airway obstruction
  • Hydrocephalus (see Hydrocephalus)
  • Hypocalcemia (see Hypocalcemia)
  • Hypokalemia (see Hypokalemia)
  • Hypokalemic Periodic Paralysis (see Hypokalemic Periodic Paralysis)
  • Idiopathic Bilateral Vocal Cord Paralysis
  • Laryngeal/Tracheal Fracture (see Tracheobronchial Fracture): with recurrent laryngeal nerve injury
  • Lyme Disease (see Lyme Disease)
    • Physiology: neuropathy involving the laryngeal nerves
  • Mediastinal Mass/Lymphadenopathy (see Mediastinal Mass): in cases where large mass or nodes impact the recurrent laryngeal nerves
  • Meningomyelocele
  • Mobius Syndrome
  • Myasthenia Gravis (see Myasthenia Gravis)
  • Paclitaxel (Taxol) (see Paclitaxel)
    • Physiology: neuropathy involving the laryngeal nerves
  • Paradoxical Vocal Fold Motion (Vocal Cord Dysfunction) (see Paradoxical Vocal Fold Motion): typically acute
  • Parkinson’s Disease (see Parkinson’s Disease): may be acute (particularly in the post-operative setting) or progressive
  • Postpolio Syndrome (see Poliomyelitis)
  • Rheumatoid Arthritis (RA) (see Rheumatoid Arthritis)
    • Physiology: arteritis of vasa vasorum of recurrent laryngeal (and vagus) nerves
  • Shy-Drager Syndrome
  • Synkinesis of the Recurrent Laryngeal Nerve
  • Systemic Lupus Erythematosus (SLE) (see Systemic Lupus Erythematosus)
    • Physiology: neuropathy involving the laryngeal nerves
  • Vincristine (see Vincristine)
    • Physiology: neuropathy involving the laryngeal nerves

Developmental Abnormality or Neoplasm the Involving Vocal Folds

Intubation Injury to Vocal Folds (see Endotracheal Tube-Associated Laryngeal Injury)

  • Acute
    • Arytenoid Dislocation
    • Excessive Endotracheal Cuff Pressure with Compression of Recurrent Laryngeal Nerve Where It Enters the Larynx
    • Hyperextension of Neck with Vagus Nerve Injury
    • Larygneal Mask Airway (LMA)-Related Injury
    • Recurrent Laryngeal Nerve Injury Due to Anterior Thyroid Cartilage Displacement (Relative to the Cricoid Cartilage)
  • Chronic
    • Excessive Endotracheal Tube Cuff Pressure with Compression of Recurrent Laryngeal Nerve Where It Enters the Larynx
    • Posterior Glottic Stenosis (PGS): due to prolonged or traumatic intubation
    • Vocal Cord Granuloma

Mechanical/Iatrogenic Injury to Vocal Folds

  • Nasogastric Tube Syndrome (see Nasogastric Tube Syndrome): first reported in 1981, it is believed to be due to paresis of the posterior cricoarytenoid muscles secondary to ulceration and infection over the posterior lamina of the cricoid
    • Risk Group: diabetic renal transplant patients (due to prolonged gastroparesis and requirement for nasogastric tube drainage)
  • Proximal Esophageal Stent Placement (see Esophageal Stent)

Radiation Injury to Vocal Folds (see Radiation Therapy)

  • Radiation-Induced Chondronecrosis of Larynx
  • Radiation-Induced Fibrosis of the Cricoarytenoid Joint and/or Vocal Cords
  • Radiation-Induced Injury to Cricoarytenoid Joint: see Cricoarytenoid Arthritis above
  • Radiation Injury to Vocal Cords

Surgical Injury to Vocal Folds

  • Anterior Cervical Disk Surgery
    • Epidemiology
      • Typically Results in Unilateral Injury (Which May Compromise the Upper Airway if Contralateral Side was Previously Injured)
  • Brainstem Surgery
    • Epidemiology
      • May Result in Bilateral Injury
  • Cardiac Surgery
  • Carotid Endarterectomy
    • Epidemiology
      • Typically Results in Unilateral Injury (Which May Compromise the Upper Airway if Contralateral Side was Previously Injured)
  • Endolaryngeal Surgery (Using Carbon Dioxide Laser)
    • Epidemiology
      • May Damage the Posterior Glottis
  • Esophageal Surgery
    • Epidemiology
      • May Result in Bilateral Injury
  • Thyroid Surgery
    • Epidemiology
      • Accounts for 48% of All Surgical Cases
      • May Result in Bilateral Injury
  • Parathyroid Surgery
    • Epidemiology
      • May Result in Bilateral Injury
  • Tracheal Surgery
    • Epidemiology
      • May Result in Bilateral Injury

Other Upper Airway Disease

Infection

Miscellaneous

  • Ammonia Inhalation (see Ammonia): typically acute
  • Anaphylaxis (see Anaphylaxis): typically acute
  • Angioedema (see Angioedema): typically acute
  • Congenital Small Cricoid Cartilage: typically progressive
  • Esophageal Foreign Body: extrinsic compression of upper airway, typically progressive
  • Langerhans Cell Histiocytosis (see Langerhans Cell Histiocytosis): typically mild upper airway obstruction
  • Laryngeal Cyst/Laryngocele: typically mild upper airway obstruction
  • Laryngeal Rheumatoid Nodule (see Rheumatoid Arthritis): typically progressive
  • Macroglossia: typically mild upper airway obstruction
  • Nasal Polyps (see Nasal Polyps): typically mild upper airway obstruction
  • Obstructive Sleep Apnea (see Obstructive Sleep Apnea): typically acute
    • Particularly in post-op setting, etc
  • Strangulation/Near Hanging (see Near Hanging): non-judicial hangings (where drop is <6.5-7.5 ft) do not fracture dens off, they result in death most commonly due to pulmonary complications
  • Thermal Injury/Burns of Upper Airway (see Smoke Inhalation): may be acute
    • Thermal injury is usually supraglottic (typically, laryngeal injury)
  • Thyromegaly/Goiter (see Goiter): typically progressive
  • Tracheal Cyst: typically progressive
  • Tracheomalacia (see Tracheobronchomalacia): typically progressive
  • Tonsillar/Adenoid Enlargement: typically progressive
  • Unilateral Vocal Cord Paralysis (see Unilateral Vocal Fold Immobility): typically mild upper airway obstruction
  • Upper Airway Foreign Body (see Airway Foreign Body): typically acute

Tracheobronchial/Central Airway Obstruction (see Central Airway Obstruction)

Tracheobronchial Infection

Tracheobronchial Neoplasm

Primary Tracheobronchial Tumor

Endobronchial Metastases (see also Lung Metastases-Endobronchial)

Extrinsic Tracheobronchial Compression

  • Enlarged Pulmonary Artery: extrinsic compression of tracheobronchial airways
    • Tetralogy of Fallot (see Tetralogy of Fallot): in infants and children
    • Transposition of Great Vessles with Ventricular Septal Defect: in infants and children
  • Granulomatous Mediastinitis and Fibrosing Mediastinitis (see Granulomatous Mediastinitis and Fibrosing Mediastinitis])
    • Physiology: extrinsic compression of tracheobronchial airways
  • Mediastinal Mass (see Mediastinal Mass): extrinsic compression of tracheobronchial airways
    • Bulky Mediastinal or Peribronchial Lymphadenopathy
    • Mediastinal Tumor
  • Thoracic Aortic Aneurysm (TAA) (see Thoracic Aortic Aneurysm): extrinsic compression of tracheobronchial airways
  • Thyroid Cancer/Thyromegaly/Goiter (see Goiter and Thyroid Cancer)
    • Physiology: extrinsic compression of trachea

Other Tracheobronchial Obstructive Process

Other Airway Obstruction

Infection

  • Scombroid (see Scombroid)
    • Physiology
      • Ingestion of Histamine-Contaminated Fish (or Swiss Cheese)
    • Clinical
      • Bronchospasm (Cough, Dyspnea, Wheezing) May Be Severe in Patients with Underlying Lung Disease
  • Herpes Simplex Virus (HSV) Tracheobronchitis (see Herpes Simplex Virus)
  • Chlamydophila Pneumoniae (see Chlamydophila Pneumoniae)

Drug

Toxin

Pulmonary Infiltrates with Eosinophilia (PIE) Syndrome (see Pulmonary Infiltrates with Eosinophilia)

Bronchiolitis Syndrome

Other

Clinical Manifestations

Pulmonary Manifestations

  • Cough (see Cough)
    • Epidemiology: common
  • Dyspnea (see Dyspnea)
    • Epidemiology: common
  • Wheezing (see Wheezing)
    • Epidemiology: common

References

Etiology

  • Assessment of upper airway anatomy in awake, sedated and anaesthetised patients using magnetic resonance imaging. Anaesth Intensive Care. 1994;22(2):165 [MEDLINE]
  • Magnetic resonance imaging of the upper airway. Effects of propofol anesthesia and nasal continuous positive airway pressure in humans. Anesthesiology. 1996;84(2):273 [MEDLINE]