Respiratory Diseases and the Fire Service - IAFF

28 Chapter 2-1 • Disorders of the Upper Aerodigestive Tract
Oral Cavity, Pharynx, and Larynx
Fortunately, an explanation of the function of the mouth and tongue is likely
not necessary. It should be noted that though we generally consider the tongue
to be responsible for our sense of taste, the tongue really only gives us the
sensations of sweetness, saltiness, bitterness, and sourness. The fine essences
of food taste are accomplished by our sense of smell.
The oral cavity structures are also lined by specialized mucous membranes.
They are separated from the nasal cavity by the hard and soft palate. The palate
may vary in size and shape in each individual, and along with the back of the
tongue and nose, have specialized lymphoid tissue attached to them termed
tonsils and adenoids. These structures may become enlarged or swollen as
a manifestation of upper airway irritation as well, and are components that
may need to be addressed in the management of various types of upper airway
obstruction including obstructive sleep apnea.
The rest of the throat is called the pharynx and larynx. Also lined by
mucous membrane, the primary functions of the larynx are maintenance of a
breathing passage, protection of the airway, and phonation. The cough reflex
is important for protecting the airway during swallowing, but also in response
to potentially noxious irritants that may be inhaled. The larynx is composed
of cartilage, muscles, and nerves along with the vocal cords. The functions of
speech, breathing, coughing, and swallowing are quite complex, with many
ways for things to go wrong or become discoordinated. Given the larynx’s role
as a primary defense of the lower respiratory tract, its function and hygiene
must not be taken for granted.
DISEASE
Rhinitis, Sinusitis, and Rhinosinusitis
Rhinitis means inflammation of the nasal cavities. Sinusitis means inflammation
of the sinuses. Since the nasal cavities and sinuses are lined by the same type
of specialized mucous membrane and the irritation and symptoms are often
continuous and closely related to one another, the term rhinosinusitis has
become popularized and preferred amongst specialists.
The extent of inflammation can be quite variable. Similarly, the symptoms
can be quite diverse even within the same individual. This may range from
simple congestion or runny nose to intense pain or pressure in the cheeks,
around the eyes, or headache. Loss of smell, weakness, tiredness, cough (often
more severe at night,) and drainage down the back of the throat (postnasal
drip) are other common manifestations of rhinosinusitis (Table 2-1.1).
We typically classify rhinosinusitis as being one of two broad categories with
different causes and courses: acute or chronic. Acute rhinosinusitis simply refers
to an inflammatory episode lasting less than two weeks. Complete resolution of
symptoms is typical in acute infections, as these are usually preceded or caused
by viral infections of the nose and sinuses often called “colds.” The typical
scenario would be that someone catches a cold that results in inflammation
of the nasal passages. If this inflammation is enough to impair the effective
circulation and clearance of the sinuses, a bacterial infection of the sinuses
(acute rhinosinusitis) may result. The symptoms of acute rhinosinusitis often