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The upper respiratory tract 

The upper respiratory tract
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date: 07 March 2021

The upper airway is anatomically defined by the carina inferiorly and pharynx superiorly, with pathology predominately arising from the trachea and larynx. Obstruction of the upper airway may arise because of a fixed structural pathology such as tracheal stenosis or malignancy, but can arise following loss of normal function (e.g. inappropriate vocal cord adduction). A high index of suspicion is required to make the diagnosis because the clinical features of upper airway obstruction can mimic other respiratory conditions. Calculation of the ratio of forced expiratory volume in one second to peak expiratory flow (Empey index) may identify patients with unsuspected upper airway obstruction.

Acute upper airway obstruction is a medical emergency and usually caused by aspiration, oedema (allergic, hereditary, and acquired angio-oedema, smoke inhalation), or infection (croup, epiglottitis, quinsy, retropharyngeal abscess). Non-acute causes of upper airway obstruction include malignancy, tracheal stenosis, tracheal compression, dynamic large airway collapse, and laryngeal dysfunction.

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