What is the Unified Airway?

Cut From The Same Cloth

The Unified Airway Model (UAM) is a theory, or model, with increasing support in the medical literature.

The theory states that the epithelial lining of the respiratory and digestive (aero-digestive) tract – from the lining of the middle ears, through the nose and sinuses, through the larynx (voice box), down the trachea and bronchioles into the lungs, as well as the esophagus (the swallowing tube) – is all similar: it has the same genetic makeup, and will respond to environmental challenges and hormones in a similar manner.

Makes sense to me.

In practical terms the UAM predicts that challenges affecting one anatomic area of the aero-digestive tract will also likely affect one or more of the other components.

The Unified Airway, and Anatomic proximity connects rhinitis, sinusitis, laryngitis, otitis, adenoiditis, and tonsillitis

It's All Connected

It’s All Connected – “Comorbid”

This means that inflammation of the ears resulting from a middle ear infection (otitis media) may also cause inflammation of the nose (rhinitis), sinuses (sinusitis), trachea (tracheitis), bronchi (bronchitis), or esophagus (esophagitis), and may trigger a lower respiratory bronchospasm (asthma).  The medical community refers to such overlap as “comorbidities,” meaning illnesses that are linked and often occur simultaneously.

What is the Evidence for UAM?

Parents of children with asthma have recognized that allergies can trigger their child’s asthma, along with rhinitis from other causes, or sinusitis, or ear infections, or reflux, or just a simple cold.  We witness this anecdotally.  We know this intuitively.  We know it from our experience.

These are termed comorbidities in these children: ear infections, allergic rhinitis, sinusitis, asthma, reflux.

In addition to our anecdotal experience, there is growing medical, scientific evidence that supports the UAM:

The Numbers

Sinusitis, Rhinitis and Asthma

Nearly 40% of people with rhinitis also have asthma.  Conversely, over half of those with asthma have chronic rhinitis.  Patients with chronic rhinosinusitis (CRS) have a 20% prevalence of asthma.  This is increased to 50%  in those who have CRS with nasal polyps.

Reflux and Otitis

In a recent study looking at reflux and ear infections: 20% of children with recurrent and chronic ear infections (otitis media) had reflux to their ears.  Only 1.4% of the children without ear infections had reflux to their ears.  See my previous post for a review of how reflux causes otitis.


The severity of nasal symptoms that I see in my pediatric patients correlates with the severity of their asthma.  Treating rhinitis and sinusitis significantly improves asthma for many children.  Treating reflux significantly improves sinusitis, chronic ear infections, and asthma for many children.

What does this mean for YOUR child?

It means that control of upper airway inflammatory diseases – ear infections, rhinitis and sinusitis – can help control lower airway disease – asthma, bronchitis.

It means that control of gastro-esophageal-reflux (GER) can help control both upper and lower airway disease:  eliminate reflux and you can reduce chronic ear infections, rhinitis, sinusitis, and asthma.  How’s that for a win/win/win?

So if your child has difficult-to-control asthma, optimal nasal hygiene will be beneficial.  This may include saline sinus rinses, it may include immune-therapy for allergies, it may include anti-reflux treatment. Check out the three previous posts on this blog, listed below in resources.

If your child has any of the other chronic aero-digestive inflammatory disorders (CAID) described here, control of reflux should be considered in addition to nasal / sinus hygiene.  Ask your doctor.

Check out the resources below, especially (I’m biased) the posts on this blog that discuss controlling allergic rhinitis and optimizing nasal hygiene.


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Best of health and success to you and your families.

Until next time, remember … you can pick your friends, and you can pick your nose, but you can’t pick your friend’s nose (unless you’re a boogor doctor :~D)

I promise to continue to work hard to help empower you with knowledge: to improve your health and the health of your children. RF


On this Blog:

The notion of a Unified Airway was first officially suggested in 2001 by Bousquet, Van Cauwenberge, Khaltaev, the Aria Workshop Group, and the World Health Organization, in the medical journal, Journal of Allergy and Clinical Immunology 108 (5 supp): S147-334; 2001.

There are more recent reviews, including an entire issue devoted to Unified Airway in the medical journal, Otolaryngology Clinics of North America 41(2), edited by an Otolaryngologist with Immunology and Allergy expertise, Dr. John Krouse.

Similar allergic inflammation in the middle ear and the upper airway: Evidence linking otitis media with effusion to the united airways concept. Nguyen, et al. Journal of Allergy and Clinical Immunology. Vol. 114: 1110-1115; 2004.

O’Reilly et al., The Role of Extraesophageal Reflux in Otitis Media in Infants and Children. Laryngoscope, 118 (Suppl. 116): 1-9; 2008.  Recently reviewed on this blog:  Does Reflux Cause Ear Infections?

Krouse, Brown, Fineman, et al. Asthma and the unified airway. Otolaryngology Head Neck Surgery. 136: S75-S106; 2007.

Jani, Hamilos. Current thinking on the relationship between rhinosinusitis and asthma. Journal of Asthma. 1: 1-7; 2005.


  1. physician assistant says:

    Valuable info. Lucky me I found your site by accident, I bookmarked it.

  2. keerat sibia says:

    Excellent article by Dr Faust.

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