Outcomes of flexible fiberoptic laryngoscopy in patients with stridor: a cross-sectional study in a tertiary care pediatric center in Saudi Arabia

Abstract

BACKGROUND: Successful evaluation of a patient with stridor requires a thorough history and physical examination followed by a flexible fiberoptic laryngoscopy (FFL), which provides visualization of the upper airway. OBJECTIVES: Estimate the prevalence of causes of stridor in children who underwent FFL and compare different age groups. Find any significant associations between symptoms and laryngoscopic findings. Identify patients who needed further evaluation using direct laryngobronchoscopy (DLB). DESIGN: Retrospective, cross-sectional. SETTING: Tertiary care center in Riyadh. PATIENTS AND METHODS: We included all pediatric patients aged 1 month to 14 years who underwent fiberoptic laryngoscopy for stridor evaluation from January 2015 to January 2018 (37 months). Patients older than the age of 14 years, and patients with a workable diagnosis with adenotonsillar hypertrophy, choanal atresia, or laryngotracheo-bronchitis (croup) were excluded. MAIN OUTCOME MEASURES: Findings of FFL. SAMPLE SIZE: 217 pediatric patients. RESULTS: The median (interquartile range) age of the patients was 5 (8) months. Laryngomalacia was the most common diagnosis (n=149, 69%) followed by laryngopharyngeal reflux (n=42, 19%). Subglottic stenosis was the most common finding in patients who underwent DLB for further evaluation (n=19, 49%). Laryngomalacia was more frequent in children ≤12 months of age (83% vs 43% in children >12 months, P <.001). Vocal cord paralysis was more common in children >12 months of age (27% vs 9%, P <.001). FFL was effective in finding the diagnosis in 178 (82%) patients; only 39 (18%) patients needed further assessment using DLB. CONCLUSION: FFL is an effective and important tool for evaluating patients with stridor. LIMITATIONS: Retrospective design and single-centered. CONFLICTS OF INTEREST: None.

Clinical application of flexible bronchoscopy in neonatal respiratory diseases

“…Common indications for bronchoscopy in neonates include unexplained cyanosis, unexplained respiratory distress, and prolonged di culty in withdrawal (9,10). In this study, the top two clinical indications were dyspnea (42.9%) and laryngeal tinnitus (39.3%), which is consistent with the ndings of many studies (11,12). Several studies have con rmed that dyspnea and laryngeal tinnitus are common clinical manifestations of developmental malformations of the respiratory tract in neonates.…”

“…Wang retrospectively analyzed the bronchoscopic data of 175 infants and children with unexplained dyspnea, suggesting that the etiology of dyspnea varies in different age groups, with respiratory malformations predominating up to 6 months of age and the proportion of respiratory malformations tending to decrease with increasing age (11). A study in Saudi Arabia showed that laryngomalacia in 217 children with laryngeal tinnitus was detected at a much higher rate in the younger age group (< 1 year) than in the older age group (> 1 year) (83% vs 43%, P < 0.001) (12). Therefore, in clinical practice, neonates with unexplained dyspnea and laryngeal tinnitus, who are suspected of having an airway abnormality that cannot be clari ed by imaging, should undergo aggressive bronchoscopy to fully evaluate the airway and help clarify the etiology at an early stage.…”