What is Airway Obstruction?
Upper airway obstruction is a condition where the airways in your body become narrowed or completely blocked, reducing your ability to breathe. It can be a temporary (acute) or long-term (chronic) condition, and it could partially or completely block the air passage. In cases where the airways are completely blocked, it means that you can’t get any air in or out of your lungs. Partial or full blockages can be life-threatening emergencies that require immediate medical attention as they severely limit your ability to breathe, which can be fatal within minutes. Prolonged airway obstruction can also cause heart and lung problems which could lead to serious health conditions or even death over time. Problems in the nose and mouth area, known as the nasal and oral pharyngeal pathology, can cause sudden or long-term blockages in the airways. The most sensitive area to obstruction is the nasal valve, where even a slight deviation can cause significant upper airway obstruction.
What Causes Airway Obstruction?
Upper airway obstruction, or trouble getting air from the nose and throat to the lungs, can be caused by a wide range of factors. This could be anything like inflammation, infection, or injury of the airway structures. Even variations in an individual’s anatomy may lead to obstruction.
There are numerous potential causes of blocked airways. These include a deviated septum (sideways or crooked nasal septum), swallowing a foreign object, overgrowth of the tongue (macroglossia), tissue webs in the windpipe (tracheal webs), undeveloped windpipe (tracheal atresia), abscesses behind the throat or tonsils, a runny nose (rhinitis), polyps, large tonsils, fatty tissue in the neck (lipoma), nasal/throat cancers, swelling from a condition called epiglottitis, injury either from blunt force or cuts, allergic reaction (anaphylaxis), enlarged nasal passages (turbinate hypertrophy), and chemical or heat-induced burns.
There’s also a long-term cause of airway blockage known as obstructive sleep apnea. This is a subset of sleep apnea, which involves repeated pauses in breathing during sleep due to a blocked or collapsed airway.
Risk Factors and Frequency for Airway Obstruction
Airway obstruction injuries often cause death in children who are younger than four years old. In adults, blocking of the airway tends to happen more often because of inflammation, infection, or an injury. Visits to the emergency department are quite common due to airway obstruction issues.
- Most children who tragically die from blocked airways are typically below the age of four.
- In adults, such incidents are frequently linked to inflammation, infection, or trauma.
- Blocked airways are a common reason for emergency department visits.
Signs and Symptoms of Airway Obstruction
In situations where someone’s airway is suddenly blocked, understanding what caused the issue can be key to choosing the right treatment. This can be tricky, as the person with the blocked airway might not be able to explain what happened. Healthcare providers may have to depend on family members or others who saw what happened to fill in the details. Diagnosing a blocked airway involves a detailed check of the head and neck.
Immediate blockages, like something a person swallowed, an injury, or a severe allergic reaction, are a real test for healthcare providers as they need to diagnose and treat the problem quickly. Those suffering might show signs of severe discomfort, confusion, or struggle in breathing. In extreme cases, they might be unresponsive or even go into cardiac arrest. The physical examination should aim to identify any fixable obstructions, especially in those experiencing extreme discomfort. Both the nose and the throat should be examined, as well as the neck, to look for any abnormalities that might be squeezing the airway.
People who have obstructive sleep apnea, a condition where breathing stops and starts during sleep, often have certain physical characteristics. These can include being overweight and having a wide, short neck. They may also have a larger tongue and a smaller jaw. Additional tools like a nose speculum with a light, rigid or flexible endoscopy (a procedure to examine your digestive tract), and direct laryngoscopy (a procedure to view your vocal cords) can help with the physical examination.
Testing for Airway Obstruction
If there is a chance someone has a serious blockage in their throat, doctors need to act quickly to assess the situation. They’ll have all the essential medical tools within easy reach in case they need to step in and clear the blockage right away. Part of the throat checkup could include using a flexible or stiff viewing tool (endoscope) to look into the nasal and throat areas. Another tool, called a laryngoscope, can also be used for both inspection and any needed treatments.
Imaging techniques can help visualize the obstruction, but doctors must proceed with extreme caution. They wouldn’t want their patient under stress while waiting for the imaging results. So instead of a delay, ideally, they want to fix the blockage first, then use the images to understand what caused the problem. After securing the patient’s condition, a side-view X-ray of the head and neck, a CT scan, or MRI can be used for this purpose.
CT scans provide detailed images of both hard and soft tissues. Also, these scans can measure the throat’s diameter and even generate three-dimensional images relatively quickly. The doctor will only decide to use a CT scan if the patient’s condition allows it, so they don’t stress the patient unnecessarily. While MRIs can also show the cause of the obstruction, especially when it involves soft tissues and the structures around them, and don’t involve radiation or always require a dye injection, their drawbacks include limited availability and high cost.
Treatment Options for Airway Obstruction
When someone is having trouble breathing due to a blocked airway, it’s essential to fix the problem quickly. If it’s not addressed, the person might not survive. This can be a critical situation, and it’s key that the airway obstruction is removed. This might involve treating the cause, but in critical cases, doctors often need to take steps to remove the blockage straight away.
To get ready to treat someone with a blocked airway, doctors should have all the necessary equipment and help at hand as soon as they can. They will need tools for procedures like nasotracheal and endotracheal intubation, where a tube is inserted into the patient’s nose or mouth and down into their lungs. They might also need surgical tools. It’s important to have specialists available, like anesthetists, emergency medicine doctors, respiratory therapists, and critical care doctors.
If doctors think they may need to do surgery, they should get a surgical consult early on. They should also gather any other equipment that may be helpful, like a bronchoscope, which is a device used to look inside the airways. The patient should be given extra oxygen, and doctors can try repositioning the patient’s head to help open up their airway. For patients who may have a neck injury, doctors need to be careful when moving their head and neck.
There are several ways to quickly improve a blocked airway. Doctors can remove anything stuck in the airway, insert a breathing tube in the patient’s nose or mouth, or do surgery like a tracheostomy or cricothyroidotomy. Sometimes, a procedure called jet insufflation can give temporary relief.
Once the airway is open, doctors will work on treating the underlying issue causing the blockage. If it’s an infection, they’ll start antibiotics and sometimes need to drain fluid. If a mass is causing the obstruction, a surgeon may need to examine it once the immediate threat to the patient’s breathing is handled. If the cause is a long-term issue like sleep apnea, doctors will do more tests and might need to do surgery or other treatments while the patient is asleep.
What else can Airway Obstruction be?
When doctors are trying to diagnose a sudden case of airway obstruction, they’re considering several possibilities, including:
- An object that’s been inhaled (aspiration)
- An infection
- Bleeding (hemorrhage)
- Swelling of the deeper layers of the skin (angioedema)
- Caused by a medical procedure (Iatrogenic, such as after surgery)
- Blunt force injury
- Injury due to inhalation
- A disease affecting the muscles (neuromuscular disease)
When doctors are diagnosing chronic, or long-term, airway obstruction, they have a similar but expanded list of possibilities:
- An infection
- Damage caused by a medical procedure (post-intubation)
- A condition where abnormal proteins build up in organs (Amyloidosis)
- The growth of abnormal cells (Sarcoidosis)
- A growth (tumor)
- An illness affecting the body’s connective tissue (Collagen vascular disease)
- A mass in the area between the lungs (Mediastinal mass)
- A tumor in the esophagus
- An abnormal heart or blood vessel structure (Cardiovascular anomaly)
- A disease affecting the muscles (neuromuscular disease)
- For cases with no clear cause (idiopathic)
- Unusually large tonsils in children
These are all potential causes of chronic airway obstruction a doctor may look into when making a diagnosis.
What to expect with Airway Obstruction
The outlook for people with blocked airways largely depends on what’s causing the problem. Generally speaking, the outlook is more positive for conditions caused by inflammation or infection, compared to those caused by cancer.
Possible Complications When Diagnosed with Airway Obstruction
The complications of a blocked airway can be severe. These are:
- Respiratory failure
- Irregular heart rhythm, also known as arrhythmias
- A sudden stop in effective blood flow, or cardiac arrest
- Death
