Flexible Laryngoscopy in Neonates, Infants, and Young Children
ABSTRACT Flexible laryngoscopy was performed 453 times on 264 patients 4 years of age or younger. Sixty-five percent were under 6 months of age. Stridor was the indication for laryngoscopy in 60% of the patients. Problems secondary to intubation and poor voice each were indications in 12%. The most common finding was laryngomalacia, followed by laryngeal edema, normal larynges, and vocal cord paralysis or paresis. Subglottic stenosis was diagnosed in 17 patients. Flexible laryngoscopy is a relatively noninvasive, safe, and effective technique for examining the larynx of infants and young children.
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ABSTRACT: Utredning och behandling av luft- vägsproblematik hos spädbarn är ett av många områden där synsätten har för- ändrats. Uppfattningen att vanliga sym- tom som ljudlig andning och andnings- uppehåll inte behöver ha negativa kon- sekvenser för ett barns hälsotillstånd har ifrågasatts och ersatts av ett mer ak- tivt förhållningssätt. Den ökade uppmärksamheten på andningsproblem hos småbarn har medfört att allt fler barn remitteras för utredning. Vid Astrid Lindgrens barn- sjukhus finns en specialiserad enhet för utredning av andningsstörningar hos barn. Antalet barn som remitteras dit har successivt ökat till omkring 170 per år. Majoriteten av patienterna är späd- barn med anamnes på ansträngd and- ning eller andningsuppehåll under sömn.
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ABSTRACT: Accurate diagnosis of upper airway abnormalities by flexible laryngoscopy in infants is hampered by rapid laryngeal motion and lack of patient cooperation. This study evaluates the added role of videorecorded flexible laryngoscopy and the objective measurement of vocal fold abduction in improving the diagnosis of upper airway abnormalities in infants. Seventy-eight infants had videorecorded flexible laryngoscopy performed as part of their evaluation of a suspected airway disorder. These recordings were reviewed by three otolaryngologists for confirmation of the clinical diagnosis. From the video image, the maximum angle of vocal fold abduction was measured with image analysis software. Of 78 patients 40 had supraglottic or glottic abnormalities, 9 had nasal or nasopharyngeal obstruction, 9 had subglottic abnormalities (diagnosed subsequent to videolaryngoscopy), and 15 patients had normal findings on examination. Of those with laryngeal abnormalities, laryngomalacia was the most common diagnosis (23 of 78). Vocal fold paralysis was present in 4 patients. A separate group (9 of 78) of patients was identified as having symmetric bilateral limitation of vocal fold abduction. Laryngeal dyskinesia was diagnosed in these 9 patients. The mean values of maximal vocal fold abduction were as follows: (1) normals, 59.5 degrees; (2) laryngomalacia, 57.0 degrees; (3) paralysis, 26.6 degrees; and (4) incomplete abduction with laryngeal dyskinesia, 27.6 degrees. Videolaryngoscopy is a valuable tool for documentation, parent education, and analysis of infant laryngeal abnormalities. Repeat viewing of the video examination and frame-by-frame analysis improve the diagnostic accuracy. Using this approach, we have calculated the anterior glottic abduction angle in the normal and abnormal infant larynx. In addition, we have identified a group of infants with incomplete abduction of the vocal folds that appears to be different from that found in vocal cord paralysis.Otolaryngology Head and Neck Surgery 05/1996; 114(4):554-61. DOI:10.1016/S0194-5998(96)70246-2 · 1.72 Impact Factor
Article: Stridor in neonates[Show abstract] [Hide abstract]
ABSTRACT: Stridor in neonates and infants is a symptom that indicates partial obstruction of the large diameter airways. Its presence should prompt a thorough examination and workup. Steps in evaluating stridor include a careful history and physical examination and rapid assessment of the severity of the clinical situation. Infants with respiratory distress and severe stridor should be safely and urgently transported to a tertiary care center, and colleagues from the departments of otolaryngology and anesthesia-critical care should be alerted. An essential component of the physical examination is auscultation. The phase of respiration in which the stridor is heard best provides important clues to help localize its cause. Radiographs, including plain films, dynamic fluoroscopic airway films, contrast esophagography, CT, and MR imaging are useful in specific clinical situations, based on the likely differential diagnosis. The anatomic causes for stridor in infants and neonates are vast. Successful management depends on expert consultation, proper equipment, and a staff that is experienced in the management of pediatric airway problems. The trend over the past decade has been to significantly decrease morbidity and mortality and also to decrease the number of tracheotomies necessary to stabilize pediatric airways. The best treatment outcomes result when there is good cooperation and communication among pediatricians, otolaryngologists, pulmonologists, and anesthesiologists.Pediatric Clinics of North America 01/1997; 43(6):1339-56. DOI:10.1016/S0031-3955(05)70522-8 · 2.20 Impact Factor