Comparison of Nasopharyngeal Airway and Oropharyngeal Airway

Airway Management Devices

Airway management devices include nasopharyngeal airways and oropharyngeal airways, put in another way, nasopharyngeal airways and oropharyngeal airways are medical devices designed for airway management. In particular, they are devices that provide airway patency (open airway). In the passages below we explain what they are.

What are a Nasopharyngeal Airway and an Oropharyngeal Airway?

1) Nasopharyngeal Airway

A nasopharyngeal airway (NPA) is a soft, flexible tube that is inserted through the nostril to provide a clear passage for air from the nose to the lower airway.

Primary materials used for nasopharyngeal airway are Silicone and PVC.

A. Silicone

Characteristics: Flexible, soft, and biocompatible.

Advantages: Silicone NPAs are more comfortable for the patient, especially for longer-term use. They are less likely to cause irritation or damage to the nasal and pharyngeal tissues.

B. PVC (Polyvinyl Chloride)

Characteristics: Rigid, durable, and cost-effective.

Advantages: PVC NPAs are generally less expensive and are used in many emergency settings. They are relatively easy to insert and manage.

Usage: Often used in disposable, single-use applications due to cost-effectiveness.

Detailed descriptions of nasopharyngeal airway are available at manufacturer websites such as that of Hangzhou Bever Medical Device Co., Ltd.

Nasopharyngeal airway from Hangzhou Bever Medical Device Co., Ltd.

2) Oropharyngeal Airway

An oropharyngeal airway (OPA) is a rigid, curved plastic device. It is used in unconscious patients without a gag reflex to maintain a patent airway by keeping the tongue from blocking the pharynx.

Common materials of this type of airways are PVC, Silicone and rubber.

Difference between Nasopharyngeal and Oropharyngeal Airway

In this section, by explaining whether to use nasopharyngeal airway or oropharyngeal airway we demonstrate the difference between nasopharyngeal and oropharyngeal airway.

Suitability of Oropharyngeal Airway

For an unconscious person, the oropharyngeal airway (OPA) is generally preferred to create a clear passage for air. This is because the oropharyngeal airway is specifically designed to prevent the tongue from falling back and obstructing the airway, which is a common issue in unconscious patients.

The oropharyngeal airway is primarily designed to lift the tongue away from the back of the throat.

The oropharyngeal airway is used in an unconscious person, because when he/she is conscious his/her gag reflex is present, in which case using an OPA could cause vomiting and further complications. However, oropharyngeal airway is only necessary when the unconscious person has airway obstruction; in particular, if the tongue or soft tissues are blocking the airway, leading to poor air movement or noisy breathing (like snoring), an OPA can help maintain a clear airway.

Suitability of Nasopharyngeal Airway

When a person is conscious or semi-conscious, his/her gag reflex is present, and therefore cannot tolerate an oropharyngeal airway. Moreover, in this case, using an OPA could cause vomiting and further complications. So in a conscious or semi-conscious person, the option is the nasopharyngeal airway.

The NPA provides an alternative route for air to pass through the nasal passage, bypassing the collapsed soft tissues in the pharynx.

In situations below the device applicable is oropharyngeal airway instead of nasopharyngeal airway.

The NPA is contraindicated in certain situations, such as when there is suspected nasal or basilar skull trauma. In such cases, an OPA is a safer and more effective option. The OPA avoids the nasal route altogether, which can be particularly important in patients with facial injuries or nasal obstructions.

Nasopharyngeal and oropharyngeal airways are devices also used in emergency management of upper airway obstruction. An elaboration is included in the next section titled Emergency Management of Upper Airway Obstruction.

Emergency Management of Upper Airway Obstruction

In the emergency management of upper airway obstruction, both nasopharyngeal airways (NPA) and oropharyngeal airways (OPA) play important roles in maintaining a patent airway. Each device has specific indications and is used depending on the cause of the airway obstruction and the patient's condition.

Indications for NPA Use

1) When the airway is obstructed by soft tissue collapse (such as the tongue falling back), but the nasal passage is clear.

2) In cases of soft tissue swelling, such as from an allergic reaction, where the nasal route can bypass the obstruction in the oropharynx.

Procedure for Insertion

1) Lubricate the NPA with a water-soluble lubricant.

2) Insert the NPA gently into the nostril, following the natural curve of the nasal passage.

3) Advance the airway until it reaches the nasopharynx, ensuring that airflow can pass through the tube into the lungs.

Choosing the Appropriate Airway Device

If the patient is unconscious without a gag reflex and the tongue is obstructing the airway, choose the OPA.

If the patient is semi-conscious or has a gag reflex, use the NPA to avoid inducing vomiting or laryngospasm.

Combining with Other Airway Management Techniques

Both the OPA and NPA can be used in conjunction with bag-valve-mask ventilation for patients who require assisted breathing.

If the airway remains obstructed despite the use of an OPA or NPA, consider more advanced airway interventions such as endotracheal intubation.