Flexible Bronchoscopy as a Valuable Tool in the Evaluation of Children with Stridor

Abstract

The aim is to determine clinical characteristics, and flexible bronchoscopy (FB) findings including associated airway abnormalities and other conditions (ex. gastroesophageal reflux disease, GERD) in children with stridor. Medical records of children who underwent FB for the evaluation of stridor between November 2008 and December 2014 were retrospectively reviewed. Demographic characteristics, symptoms, FB finding and presence of associated conditions were assessed. Seventy-two children were enrolled in the study. Among the 72 children, 51 (70.8%) patients were less than one year old. Among all patients, laryngomalacia was the most common etiology of stridor (n=43, 59.7%),which was isolated in 12 patients, GERD in 10 patients, and 26 patients had secondary airway lesions (SALs). Diagnoses other than laryngomalacia such as subglottic hemangioma, adenoid hypertrophy, and laryngeal cyst were found in 29 patients. There was a high incidence of SALs in patients with laryngomalacia. The results of laryngomalacia were predominantly in the group with age of less than one year. There were seven patients more than 5 years of age but only one was diagnosed with laryngomalacia. Other diagnoses included pharyngomalacia, vocal cord paralysis, and airway inflammation. Noticeably, among the severe patients with stridor those more than 5 years of age, 6 patients had underlying neurological problems including cerebral palsy in 3, hypoxic ischemic encephalopathy in 1, and post encephalitis epilepsy in 2. In conclusion, FB is a helpful tool for identifying these airway anomalies among patients with stridor. Laryngomalacia with SALs accounted for a high fraction in our study. Stridor in elder children always has underlying diseases.