Flexible Minibronchoscopy in Children

1987 ◽  
Vol 96 (6) ◽  
pp. 645-649 ◽  
Author(s):  
Robert F. Ward ◽  
James E. Arnold ◽  
Gerald B. Healy
Keyword(s):  
Pediatric Population ◽  
Upper Airway ◽  
Flexible Endoscopy ◽  
Rigid Bronchoscopy ◽  
Upper Aerodigestive Tract ◽  
Treatment Plans ◽  
Tracheal Disease ◽  
Mucous Plug ◽  
Airway Dynamics

Flexible endoscopy is assuming a role of increasing importance in the evaluation and diagnosis of upper aerodigestive tract disorders. With improved fiberoptic capabilities and miniaturization, these techniques are gaining in applicability to the pediatric population. At Children's Hospital, Boston, a newly designed Machida 1.9-mm bronchoscope has been employed in the evaluation of the upper airway. The use of this small caliber instrument has been investigated in 1) evaluation of endotracheal or tracheotomy tube position, thus decreasing the need for repeated chest radiographs to confirm location; 2) bedside evaluation of possible tracheal disease (eg, mucous plug, granuloma, tracheitis) in the intensive care unit patient to determine treatment plans and/or need for further rigid bronchoscopy, and 3) evaluation of airway dynamics in the awake patient. Our experience with the flexible fiberoptic minibronchoscope is reviewed, with a discussion of indications for its use, as well as possible limitations. Case studies are presented to demonstrate the usefulness of the instrument.

scholarly journals The Role of BPIFA1 in Upper Airway Microbial Infections and Correlated Diseases

2018 ◽  
Vol 2018 ◽  
pp. 1-11 ◽  
Author(s):  
Yung-An Tsou ◽  
Min-Che Tung ◽  
Katherine A. Alexander ◽  
Wen-Dien Chang ◽  
Ming-Hsui Tsai ◽  
...  
Keyword(s):  
Nasal Cavity ◽  
Soft Palate ◽  
Upper Airway ◽  
Diagnostic Value ◽  
Secretory Protein ◽  
Immune Defense ◽  
Upper Aerodigestive Tract ◽  
Airway Diseases ◽  
Microbial Infections

The mucosa is part of the first line of immune defense against pathogen exposure in humans and prevents viral and bacterial infection of the soft palate, lungs, uvula, and nasal cavity that comprise the ear-nose-throat (ENT) region. Bactericidal/permeability-increasing fold containing family A, member 1 (BPIFA1) is a secretory protein found in human upper aerodigestive tract mucosa. This innate material is secreted in mucosal fluid or found in submucosal tissue in the human soft palate, lung, uvula, and nasal cavity. BPIFA1 is a critical component of the innate immune response that prevents upper airway diseases. This review will provide a brief introduction of the roles of BPIFA1 in the upper airway (with a focus on the nasal cavity, sinus, and middle ear), specifically its history, identification, distribution in various human tissues, function, and diagnostic value in various upper airway infectious diseases.

Endoscopic Treatment of Upper Airway and Digestive Tract Lesions Caused by Caustic Agents

2003 ◽  
Vol 112 (1) ◽  
pp. 29-36 ◽  
Author(s):  
Roberto Saetti ◽  
Umberto Barion ◽  
Marina Silvestrini ◽  
Loris Mirri ◽  
Cesare Cutrone ◽  
...  
Keyword(s):  
Digestive Tract ◽  
Endoscopic Treatment ◽  
Essential Role ◽  
Case Series ◽  
Upper Airway ◽  
Endoscopic Management ◽  
Upper Aerodigestive Tract ◽  
Rigid Endoscopy ◽  
Grade 3

We present our experience in the endoscopic management of upper aerodigestive tract lesions caused by caustic agents. Between 1985 and 2000, 112 patients with upper airway and digestive tract lesions due to caustic agents were treated at the Airways Endoscopic Surgery Unit of Padua Hospital: 44 were male and 68 were female, and the median age was 42.6 years. A retrospective statistical analysis of our case series was made to evaluate the factors that most influenced the severity of injuries and the outcome of treatment. All of the patients underwent videoendoscopic assessment. In 79 cases, the patients came under our observation in the acute phase, whereas 33 presented a picture of chronic lesions. Acute lesions were classified into 3 grades. All acute grade 1 lesions healed spontaneously. In the 32 patients with grade 2 lesions, endoscopic treatment based on removal of necrotic tissue, dilations, and cleansing of abnormal fibrin adhesions resolved the disease in 30 cases (94%). Nine patients (43%) with acute grade 3 lesions developed severe chronic lesions that required subsequent treatments. Rigid endoscopy with diode laser-assisted radial lysis was performed in 32 patients with chronic cicatricial lesions and was successful in 30 cases (94%). We reiterate the need for a standardized multidisciplinary protocol for treating lesions caused by caustic agents and emphasize the essential role of airway and digestive canal videoendoscopy in the diagnosis and treatment of both the acute lesions and chronic cicatricial sequelae.

scholarly journals Reliability and Accuracy of Remote Fiberoptic Nasopharyngolaryngoscopy in the Pediatric Population

2020 ◽  
pp. 014556132091910
Author(s):  
Lauren E. Miller ◽  
Adva Buzi ◽  
Ashley Williams ◽  
Rachel S. Rogers ◽  
Angel G. Ortiz ◽  
...  
Keyword(s):  
Pediatric Population ◽  
Upper Airway ◽  
Office Visit ◽  
Rater Agreement ◽  
Vocal Cords ◽  
Coupling Device ◽  
Overall Evaluation ◽  
Survey Results ◽  
Device Use ◽  
False Vocal

Introduction: Telemedicine is an increasingly prevalent component of medical practice. In otolaryngology, there is the potential for telemedicine services to be performed in conjunction with device use, such as with a nasolaryngoscope. This study evaluates the reliability of remote examinations of the upper airway through an iPhone recording using a coupling device attached to a nasopharyngolaryngoscope (NPL). Methods: A prospective, blinded study was performed for pediatric patients requiring an NPL during an office visit. The NPL was performed using a coupling device attached to a smartphone to record the examination. A second, remote otolaryngologist then evaluated the recorded examination. Both otolaryngologists evaluated findings of anatomic sites including nasopharynx, oropharynx, base of tongue, larynx including subsites of epiglottis, arytenoids, aryepiglottic folds, false vocal cords, true vocal cords, patency of airway, and diagnostic impression, all of which were documented through a survey. Results of the survey were evaluated through inter-rater agreement using the κ statistic. Results: Forty-five patients underwent an NPL, all of which were included in the study. The average age was 4.9 years. The most common complaint requiring NPL was noisy breathing (n = 16). The inter-rater agreement for overall diagnosis was 0.74 with 80% percent agreement, rated as “good.” Other anatomic subsites with “good” or better inter-rater agreement were nasopharynx (0.75), oropharynx (0.75), and true vocal cords (0.71), with strong percentage agreement of 89%, 91%, and 87%, respectively. Both users of the adaptor found the recording setup to run smoothly. Conclusion: A telemedicine device for NPL use demonstrates strong diagnostic accuracy across providers and good overall evaluation. It holds potential for use in remote settings.

Ventilatory dynamics during transient arousal from NREM sleep: implications for respiratory control stability

1996 ◽  
Vol 80 (5) ◽  
pp. 1475-1484 ◽  
Author(s):  
M. C. Khoo ◽  
S. S. Koh ◽  
J. J. Shin ◽  
P. R. Westbrook ◽  
R. B. Berry
Keyword(s):  
Respiratory Control ◽  
Upper Airway ◽  
Nrem Sleep ◽  
Before And After ◽  
Stage 2 Sleep ◽  
Repeated Administrations ◽  
Time Courses ◽  
Control Stability ◽  
Airway Dynamics ◽  
Normal Adults

The polysomnographic and ventilatory patterns of nine normal adults were measured during non-rapid-eye-movement (NREM) stage 2 sleep before and after repeated administrations of a tone (40-72 dB) lasting 5 s. The ventilatory response to arousal (VRA) was determined in data sections showing electrocortical arousal following the start of the tone. Mean inspiratory flow and tidal volume increased significantly above control levels in the first seven breaths after the start of arousal, with peak increases (64.2% > control) occurring on the second breath. Breath-to-breath occlusion pressure 100 ms after the start of inspiration showed significant increases only on the second and third postarousal breaths, whereas upper airway resistance declined immediately and remained below control for > or = 7 consecutive breaths. These results suggest that the first breath and latter portion of the VRA are determined more by upper airway dynamics than by changes in the neural drive to breathe. Computer model simulations comparing different VRA time courses show that sustained periodic apnea is more likely to occur when the fall in the postarousal increase in ventilation is more abrupt.

scholarly journals Computed tomographic evaluation of the role of craniofacial and upper airway morphology in obstructive sleep apnea in Chinese

2004 ◽  
Vol 98 (4) ◽  
pp. 301-307 ◽  
Author(s):  
Bing Lam ◽  
Clara G.C Ooi ◽  
Wilfred C.G Peh ◽  
I Lauder ◽  
Kenneth W.T Tsang ◽  
...  
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Upper Airway ◽  
Computed Tomographic ◽  
Obstructive Sleep ◽  
Airway Morphology

The Role of Vascular Tone in the Control of Upper Airway Collapsibility

1990 ◽  
Vol 141 (6) ◽  
pp. 1569-1577 ◽  
Author(s):  
Michael J. Wasicko ◽  
Douglas A. Hutt ◽  
Richard A. Parisi ◽  
Judith A. Neubauer ◽  
Reuben Mezrich ◽  
...  
Keyword(s):  
Vascular Tone ◽  
Upper Airway ◽  
Airway Collapsibility ◽  
Upper Airway Collapsibility

Sleep and Violence*

1984 ◽  
Vol 29 (2) ◽  
pp. 132-134 ◽  
Author(s):  
L.B. Raschka
Keyword(s):  
Differential Diagnosis ◽  
Sleep Apnea ◽  
Central Sleep Apnea ◽  
Upper Airway ◽  
Violent Behaviour ◽  
Car Accidents ◽  
Prevention And Treatment ◽  
Respiratory Pathology ◽  
The Brain

Most violence connected with sleep disorder is assumed to be related to sleep walking. It is less well known that other sleep disorders can also give rise to violence. The role of narcolepsy in car accidents is mentioned. Sleep drunkenness can lead to confusion resulting in violent behaviour especially on forced awakening. This condition is associated to sleep apnea. Primary or central sleep apnea is caused by disorders of the brain stem affecting the respiratory center. Secondary or upper airway sleep apnea can be caused by virtually any condition that results in cessation of the airflow due to occlusion of the upper airway. The author describes one patient who engaged in assaultive behaviour on forced awakening following earlier alcohol consumption. The pathomechanism of violent behaviour generated by a combination of sleep apnea and respiratory pathology is described. The differential diagnosis, prevention and treatment is outlined. The use of polysomnography in diagnosis and the potentially dangerous effects of drugs with respiratory depressing effects is highlighted.

scholarly journals Role of Taste Receptors as Sentinels of Innate Immunity in the Upper Airway

2018 ◽  
Vol 2018 ◽  
pp. 1-8 ◽  
Author(s):  
Neil N. Patel ◽  
Alan D. Workman ◽  
Noam A. Cohen
Keyword(s):  
Airway Epithelium ◽  
Taste Receptor ◽  
Upper Airway ◽  
Airway Disease ◽  
G Protein Coupled Receptors ◽  
Innate Immune ◽  
Taste Receptors ◽  
Taste Sensation ◽  
G Protein Coupled

Evidence is emerging that shows taste receptors serve functions outside of taste sensation of the tongue. Taste receptors have been found in tissue across the human body, including the gastrointestinal tract, bladder, brain, and airway. These extraoral taste receptors appear to be important in modulating the innate immune response through detection of pathogens. This review discusses taste receptor signaling, focusing on the G-protein–coupled receptors that detect bitter and sweet compounds in the upper airway epithelium. Emphasis is given to recent studies which link the physiology of sinonasal taste receptors to clinical manifestation of upper airway disease.

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