#tables see: [Rosen paediatric upper airway obstruction and infections](x-devonthink-item://C2DB9763-13C5-406C-9947-408A728F89B7?page=7), [Deranged physiology - child stridor](https://derangedphysiology.com/main/required-reading/neonatal-and-paediatric-problems/Chapter%20215/child-stridor), [Dunn - Sore throat](x-devonthink-item://3D621A72-9E95-4509-9C54-F9308AA0069E) see also: [[cough (paeds)]], [[Stridor]], [[Sore throat]] > slightly different table in the [[Stridor]] symptoms section | DDx | features | | --------------------------------------------------- | ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- | | [[Croup]] | - young<br>- rapid onset harsh barking cough<br>- hoarse voice<br>- stridor<br>- miserable<br>- febrile but generally systemically well | | [[Anaphylaxis]] | - swelling of face and tongue<br>- wheeze<br>- urticarial rash<br>- vomiting<br>- allergen exposure<br>- haemodynamic compromise | | [[inhaled foreign body]] | - young child or developmental delay<br>- very sudden onset<br>- [[cough (paeds)\|coughing]] , choking, vomiting<br>- may have unilateral chest findings, wheeze | | reduced pharyngeal tone | - reduced conscious state after drug ingestion, seizure, head injury | | [[Parapharyngeal abscess\|retropharyngeal abscess]] | - sore throat<br>- fever<br>- neck pain and stiffness or [[Torticollis]]<br>- fullness and erythema of posterior pharyngeal wall; may be midline but can be laterally behind tonsil<br>- dysphagia and drooling | | [[peritonsilar abscess]] (quinsy) | - severe sore throat, usually unilateral<br>- hot potato / muffled voice<br>- trismus<br>- swollen posterior palate and tonsil, with medial displacement of tonsil and deviation of the uvula | | epiglottitis | - inadequate Hib immunisation or immunocompromised<br>- high fever and systemically unwell<br>- muffled voice<br>- hyperextension of neck<br>- dysphagia<br>- pooling seretions, drooling<br>- absent cough<br>- low pitched expiratory stridor or stertor | | bacterial tracheitis | - systemically unwell<br>- more severe and rapidly progressive symptoms<br>- recent URTI<br>- markedly tender trachea<br>- cough may be productive with thick secretions | | [[Ludwig angina]] | - infection of sublingual and submandibular spaces<br>- swollen, tender floor of mouth and under tongue<br>- facial laceration or dental abscess | | airway burns | | | trauma | | **Simplified differential diagnosis of upper airway symptoms** | condition | distinguishing features | | --------------------------------------------------- | ------------------------------------------------------------------------------------------- | | [[Anaphylaxis]] | abrupt onset, associated trigger, other organ system involvement | | [[Croup]] | URTI sx, acute onset barking cough, stridor, no distinct positional preference | | bacterial tracheitis | fever, toxicity, prolongation of symptoms, lack of response to croup treatment | | epiglottitis | *drooling* predominant symptom, desire to remain sitting. muffled voice, no cough, anxiety | | [[Parapharyngeal abscess\|retropharyngeal abscess]] | fever, toxicity, [[Torticollis]], neck pain/stiffness, +/- drooling, +/- muffled voice | | [[inhaled foreign body\|foreign body aspiration]] | history of choking, no URTI sx or hoarseness | | [[peritonsilar abscess]] | sore throat, *trismus*, muffled voice, pharyngeal erythema and oedema, uvular deviation | ![[Pasted image 20240803002044.png|from Rosen]]