Overview
Upper respiratory tract obstruction refers to partial or complete blockage of airflow in the upper respiratory tract, often caused by inflammation, infection, anatomical abnormalities, or tumors, impacting breathing and potentially requiring specific diagnostic and therapeutic interventions. 25Diagnosis
Clinical Evaluation: Assess symptoms such as stridor, dyspnea, and difficulty breathing.
Imaging: Utilize computed tomography urography (specifically relevant for UTUC but imaging generally useful) 1.
Endoscopic Examination: Ureterorenoscopy with biopsies for suspected malignancies or structural abnormalities 1.
Symptom Severity Scales: Use visual analogue scales to measure severity of signs and symptoms 2.Management
Conservative Treatment: For low-risk conditions, consider non-invasive approaches like ureterorenoscopy laser ablation 1.
Surgical Intervention: Radical nephroureterectomy (RNU) recommended for high-risk disease 1.
Antimicrobial Therapy: Broncalt®, a class II Medical Device, shows efficacy in managing chronic upper airways disease through anti-inflammatory and antimicrobial effects 2.
Sedation for Procedures: Ketamine with or without midazolam and fentanyl for sedation during procedures like bronchoscopy, with careful monitoring for complications 3.Special Populations
Pediatrics: Ketamine sedation effective and safe in infants undergoing flexible fiberoptic bronchoscopy, with minor complications primarily mild hypoxemia 3.
Comorbidities: Management strategies may need adjustment in patients with chronic airway inflammation, considering the impact on NO output and microbial colonization 5.Key Recommendations
Utilize ureterorenoscopy with biopsies for definitive diagnosis of upper tract urothelial carcinomas (UTUC) and assess risk stratification based on tumor grade and imaging findings (Evidence: Strong 1).
Employ conservative treatments like ureterorenoscopy laser ablation for low-risk UTUC patients, reserving radical nephroureterectomy for high-risk cases (Evidence: Strong 1).
Consider Broncalt® for safe and effective management of chronic upper airways disease due to its anti-inflammatory and antimicrobial properties (Evidence: Moderate 2).
Ketamine sedation is a viable option for infants undergoing bronchoscopy, with close monitoring for minor complications like hypoxemia (Evidence: Moderate 3).References
1 Roumiguié M, Seisen T, Masson-Lecomte A, Prost D, Allory Y, Xylinas E et al.. French AFU Cancer Committee Guidelines - Update 2024-2026: Upper urinary tract urothelial cancer (UTUC). The French journal of urology 2024. link
2 Cupido GF, Gelardi M, La Mantia I, Aragona SE, Vicini C, Ciprandi G et al.. Broncalt®, class II medical device, in patients with chronic relapsed upper airways disease: a survey in clinical practice. Acta bio-medica : Atenei Parmensis 2019. link
3 Berkenbosch JW, Graff GR, Stark JM. Safety and efficacy of ketamine sedation for infant flexible fiberoptic bronchoscopy. Chest 2004. link
4 Cohen B. The Royal National Throat, Nose and Ear Hospital in World War II: a reminiscence. The Journal of laryngology and otology 2003. link
5 Djupesland PG, Chatkin JM, Qian W, Haight JS. Nitric oxide in the nasal airway: a new dimension in otorhinolaryngology. American journal of otolaryngology 2001. link
6 Federspil P, Bach R. Cefaclor in the treatment of infections of the ears, nose, and throat. Postgraduate medical journal 1979. link
7 Quick CA. Comparison of penicillin and trimethoprim-sulfamethoxazole in the treatment of ear, nose and throat infections. Canadian Medical Association journal 1975. link