Office‐Based Lower Airway Endoscopy: Feasibility and Safety

Abstract

Objectives The primary aim of this study was to identify the ease and safety of office‐based lower airway endoscopy (OLAE) in patients with and without comorbidities. In addition, we identified the most common indications for OLAE and the associated diagnosis. Methods A retrospective review on 567 patients and 706 in‐office flexible fiberoptic procedures was performed. Using a previously established grading system, the ease of visualization of the subglottis, trachea, and carina was assessed, in addition to the overall ease of the exam. Results Four hundred and eighty‐eight videos were available for review. Of those, 105 videos included an OLAE, accounting for 21.5% of all procedures. Laryngomalacia was the most common diagnosis in 35 of 105 (36%) OLAE. For all laryngomalacia cases, the overall ease was found to be on average 2.15 (standard error 0.12). Fisher exact testing showed a statistical significance in the ability to visualize the trachea between the types of Laryngomalacia (LM) (P = .035). Fisher exact testing was performed comparing LM types I, II, or III, and combined types of LM; no statistical difference was found between groups. In 4.76% of OLAE procedures, a subglottic pathology was diagnosed. Comorbidities were found in OLAE 26 of 105 patients. There were no complications identified. Conclusion We found OLAE more challenging than previously reported. OLAE of combined types of laryngomalacia was subjectively more difficult, but this difference did not reach statistical significance. OLAE continues to be a safe alternative to operative laryngoscopy in pediatric patients and appears safe in those with comorbidities when precautions are taken. Level of Evidence 4. Laryngoscope, 131:E649–E652, 2021

We Asked the Experts: Fiberoptic Laryngoscopy Needs to be Included as an Adjunct to Primary Survey (ATLS) After Neck Trauma

“…Fiberoptic laryngoscopy is often utilized in the neck trauma patient, but here we are stressing the need for it to be early in the management before the patient leaves the trauma bay. Fiberoptic laryngoscopy is obviously not a completely benign procedure, yet there is enough data in the adult population showing that it's safe and effective, and we strongly feel the pros outweigh the cons [8]. Large multicenter retrospective studies are needed to show quantitative data on delayed emergent intubations and neck/laryngeal infections after neck trauma.…”