UPPER AIRWAY

INFECTIONS
 Introduction
 Common condition that affect most people
on occasion.
 Some infections are cute that symptoms
last for several days.
 Others are chronic with symptoms with
symptoms that last for long time or recur.
 Patients seldom require hospitalisation.
 RHINITIS
 A group of disorders characterised by
inflammation and irritation of the mucous
membranes of the nose.

Classified as: a) non allergic

b) allergic
Rhinitis may be an acute or chronic
condition.
 Pathophysiology
 Nonallergic may be caused by a variety of
factors including environmental factors
such as changes in temperature or
humidity, odors, or foods; infections; age;
systemic disease; drugs (cocaine) or
prescribed medications (Anti hypertensive,
oral contraceptives; or the presence of
foreign body
 Cont…
Rhinitis may also be manifested of an allergy.
There are same pathological processes involved in rhinitis
and sinusitis.

 Mucous membranes lining the nasal passages become

inflamed, congested, and oedematous.
 The swollen nasal conchae block the sinus openings,
and mucous is discharged from the nostrils.
 Sinusitis is also marked by inflammation & congestion,
with thickened mucous secretions filling the sinus
cavities and occluding the openings.
 Clinical manifestation
 Rhinorrhea (excessive nasal discharge,
runny nose).
 Nasal congestion
 Nasal discharge (purulent with bacterial
rhinitis)
 Nasal itchiness
 Sneezing
 Headache may occur if sinusitis is also
present.
 management
 Depends on the cause ie minimise
exposure to allergies.
 Corticosteroids may be required.
 Management focuses on symptom
relief;Antihistamines for sneezing,itching
and rhinorrhea
 Oral decongestant
 Ophthalmic agents
 Viral rhinitis(common cold)
 The term “common cold” often used when
referring to upper respiratory tract infection that
it is self-limited & caused by a virus (viral rhinitis)
 Characterised by nasal congestion, rhinorrhea,
sneezing, sore throat and malaise.
 Term “cold” refers an afebrile, infectious, acute
inflammation of mucous membrane of the nasal
cavity.
 Colds are highly contagious because the virusis
shed for about 2 days before the symptoms
appear & during the first part of the symptomatic
phase.
 cause
Six viruses known to produce the S&S;
 Rhinovirus
 Parainfluenza virus
 Coronavirus
 Respiratory syncytial virus (RSV)
 Influenza virus and
 Adenovirus
 Cont..
 Each virus may have multiple strains ie;
there are over 100 strains of rhinovirus
which accounts for 50% of all colds.
 Clinical manifestation
 Nasal congestion
 Runny nose
 Sneezing
 Nasal discharge
 Nasal itchiness
 Tearing watery eyes
 “scratchy” or sore throat
 General malaise
 Low grade fever
 Chills
 Headache
 Muscle aches
 Cont…
 Cough usually appears as illness
continues.
 It can exacerbates the herpes simplex
commonly called the cold sore.
 Symptoms last from 1 – 2 weeks
 management
 No specific treatment
 Symptomatic therapy.
 Provide adequate fluid intake
 Encourage rest
 Prevent chilling
 Increase intake of vitamin c
 Use expectorants as needeed
 Warm & salt water gargles sooth the sore throat
 NSAIDS ie Aspirin or ibuprofen
 Anti histamines
 Topical nasal decongestants
 ACUTE SINUSITIS
Def;-
It is an infection of the paranasal sinuses.

Sinuses,mucus lined cavities filled with air that drain

normally into the nose,are involved in a high proportion
of URTI.
If their openings into the nasal passages are clear,the
infections resolve promptly
However,if their drainage is obstructed by the deviated
septum or by hypertrophied turbinates,spurs or nasal
polyps or tumors,sinus infection may persists to purulent
discharge.
 Cont…
 Some pple are prone to sinusitis because
of occupation ie exposure enviromental
hazards such as paint,sawdust, chemicals
that cause chronic inflammation of the
nasal passages.
 pathophysiology
 Develops as a result of of an URTI such as unresolved
viral or bacterial infection or an exacerbation of allergic
rhinitis.
 Nasal congestion caused by inflammation, oedema &
transudation of fluid, leads to obstruction of the sinus
cavities.
 This provides an excellent condition for bacterial growth.
 Organisms are s.pneumoniae,H.influenzae,moraxella
catarrhalis
 Dental infection also have been associated with acute
sinusitis.
 Clinical manifestation
 Facial pain
 Pressure over affected sinus affected
 Nasal obstruction
 Fatigue
 Purulent nasal discharge
 Fever
 Headache
 ear pain
 Cont…
 Dental pain
 Cough
 Decreases sense of smell
 Sore throat
 Eyelid edema
 Facial congestion or fullness
It is difficult to differentiate from URI or
Allergic rhinitis
 management
 Treat infection -Amoxicilin, Augumentin
-Azithromycin, Quinolones
 Shrink the nasal mucosa – use of oral &
topical decongestant
 Antihistamines if allergy is suspected
 Relieve the pain
 complications
 Meningitis
 Brain abscess
 Ischeamic infarction
 Osteomyelitis
 Orbital cellulitis
 CHRONIC SINUSITIS
 Is an inflammation of the of the sinuses
that persists for more than 3 weeks in an
adult and 2 weeks in a child.
 pathophysiology
 Narrowing or obstruction in the ostia of the
frontal, maxillary, and anterior ethmoid usually
causes chronic sinusitis, preventing adequate
drainage to the nasal passages.
 This combined area is known as the
osteomeatal complex.
 Blockage that persists for greater than 3 weeks
in an adult may occur because of infection,
allergy,or structural abnormalities.
 pathophysiology
 This results in stagnant secretions, an
ideal medium for infection. The organisms
that cause chronic sinusitis are the same
as those implicated in acute sinusitis.
 Immunocompromised patients are at
increased risk for developing fungal
sinisitis.
 Aspergillus fumigatus is the most common
organism with fungal sinusitis
 Clinical manifestation
 Impaired mucociliary clearance &
ventilation
 Cough ( thick discharge constantly drips
backward into the nasal pharynx)
 Chronic hoarseness
 Chronic headaches in the periorbital
area,and facial pain.
 Symptoms are common in the morning.
 Clinical manifestation
 Fatigue
 Nasal stuffiness
 Decrease in smell
 Decrease in taste
 Fullness in the ears
 Medical management
 Same as of acute sinusitis
(amoxyl,augumentin,ampicillin,quinolones)
 Decongestant
 Antihistamines
 Oral cortcosteroids
 Anti fungals in suspected
 If medical management fails surgical
intervention ie(excising & cauterisation of
nasal polyp)
 complication
 Severe orbital cellulitis
 Subperiosteal abscess
 Cavernous sinus thrombosis
 Meningitis
 Encephalitis
 Ischemic infarction
 PHARYNGITIS
 An inflammation or infection in the throat, usually
causing symptoms of a sore throat.
 The most common viruses causing pharyngitis
belong to the adenovirus group, which consists
of about 32 serotypes.
 Endemic adenovirus infection causes the
common sore throat, in which the oropharynx
and soft palate are reddened and the tonsils are
inflamed and swollen.
 Within 1-2 days the tonsillar lymph nodes
enlarge.
 pathophysiology
 The body responds by triggering an
inflammatory response in the pharynx.
 This results in pain,fever,vasodilation,
edema and tissue damage, manifested by
redness & swelling in the tonsillar
pillars,uvula & soft palate.
 A creamy exudate may be present in the
tonsillar pillars
 manifestation
 Occasionally, localized epidemics occur,
particularly in schools in the summer-time,
with episodes of fever, conjunctivitis,
pharyngitis and lymphadenitis of the neck
glands; these are due to adenovirus
serotype 8.
 These diseases are self-limiting, and
symptomatic treatment is all that is
required.
 Cont..
 In the past about one-third of sore throats
were due to bacterial infections, e.g.
haemolytic streptococcus, but this
proportion appears to be falling.
 Fever
 Malaise
 Lymphadenopathy of cervical
 management
 Persistent and severe tonsillitis requires
antibiotic therapy.
 Phenoxymethylpenicillin (500 mg four
times a day) or cefaclor (250 mg three
times daily) can be used.
 Avoid amoxicillin and ampicillin if there is
a possibility of infectious mononucleosis
 Viral pharyngitis is treated with supportive
measures since no effect of antibiotics
 Influenza
 The influenza virus belongs to the
orthomyxovirus group and exists in two
main forms, A and B.
 Influenza B is associated with localized
outbreaks of milder nature, whereas
influenza A is the cause of world-wide
pandemics.
 Influenza A has a capacity to develop new
antigenic variants at irregular intervals.
 Cont..
 Human immunity develops against the
haemagglutinin (H) antigen and the
neuraminidase (N) antigen on the viral surface.
 Major shifts in the antigenic make-up of
influenza A viruses provide the necessary
conditions for major pandemics, whereas minor
antigenic drifts give rise to less severe
epidemics because immunity in the population is
less blunted.
 Clinical features
 The incubation period of influenza is usually 1-3
days.
 The illness starts abruptly with a fever, shivering
and generalized aching in the limbs.
 This is associated with severe headache,
soreness of the throat and a persistent dry
cough that can last for several weeks.
 Influenza viruses can cause a prolonged period
of debility and depression that may take weeks
or months to clear; this is known as the postviral
syndrome.
 complications
 Secondary bacterial infection, particularly with
Strep. pneumoniae and H. influenzae, is
common following influenza virus infection.
 Rarer, but more serious, is the development of
pneumonia caused by Staph. aureus, which has
a mortality of up to 20%.
 Postinfectious encephalomyelitis rarely occurs
after infection with influenza virus.
 Diagnosis & treatment
 Laboratory diagnosis is not usually
necessary, but a definitive diagnosis can
be established by demonstrating a fourfold
increase in the complement-fixing antibody
or the haemagglutinin antibody when
measured before and after an interval of 1-
2 weeks or demonstration of the virus in
throat or nasal secretion.
 Treatment
 Bed rest and paracetamol, together with
antibiotics for individuals who have chronic
bronchitis, heart or renal disease.
 Protection by influenza vaccines is only
effective in up to 70% of people and is of
short duration, usually lasting for only a
year. This is prophylaxis
 Tonsillitis & adenoiditis
 Tonsils are composed of lymphatic tissue
and are situated on each side of the
oropharynx.
 The faucal or palatine tonsils and lingual
tonsils are located behind the pillars of
fauces & toungue,respectively.
 They frequently serve as the site of acute
infection (Tonsillitis)
 Cont…
 Chronic tonsillitis is less common and may
be mistaken for other disorders such as
allergy, asthma, & sinusitis.
 Adenoids or pharyngeal tonsil consists of
lymphatic tissue near the center of the
posterior wall of the nasopharynx.
 Infections of the adenoids frequently
accompanies acute tonsillitis.
 Aetiology
 Group A beta-streptococcus is the most
common organism associated with
tonsillitis & adenoiditis.
 Clinical manifestation
 Sore throat
 Fever
 Snoring
 Difficulty in swallowing.
 Enlarged adenoids may cause;-mouth
breathing, earache, draining ears,frequent
head colds, bronchitis, foul-smelling
breath, voice impairment & noisy
respiration
 Diagnosis
 P/E
 Culture & sensitivity on site for bacterial
S&S
 Management
 Oral penicillin –amoxyl ,Erythromycin x7/7
 Tonsillectomy if medical treatment has
failed & recurrent tonsillitis