Pediatric laryngotracheal obstruction: Current perspectives on stridor

Research output: Contribution to journalArticle

22 Citations (Scopus)

Abstract

OBJECTIVES/HYPOTHESIS: To assess how medical advances have impacted the diagnosis, management, and outcomes of pediatric laryngotracheal obstruction, and to describe the advantages of audio-video documentation of stridorous children. STUDY DESIGN AND METHODS: Retrospective. METHODS AND MATERIALS: 268 patients were referred for suspected laryngotracheal obstruction during the 30 months between September 1, 1995 and March 1, 1998: 173 had 206 flexible fiberoptic laryngoscopies, and 160 had 273 direct laryngoscopies. One hundred and forty-one children were identified with laryngotracheal obstruction, yielding 40 different diagnoses that could be classified into 9 major categories. Thirty-six children (25.5%) had multiple sites of upper airway obstruction. RESULTS: 138 children had follow-up >1 month. Twelve children died (8.7%), leaving 126 survivors (mean follow-up = 21.1 months). Outcomes were classified as resolved (44.2%), improved (37.0%), stable (9.4%), failed (0.7%), or death (8.7%). Better outcomes were seen in more readily treated diagnostic categories, such as tracheobronchial foreign body, chronic laryngitis, and suprastomal granulation tissue; laryngeal stenosis, tracheomalacia, and recurrent respiratory papillomatosis, had less favorable outcomes (P <.001). The former group also showed superior outcome compared to laryngomalacia (P <.001) and vocal cord mobility disorders (P = .004). Ninety-four patients (68.1%) had comorbidities complicating their management. Comorbid conditions were universal among deceased patients and least common in the resolved outcomes category (56.7%), supporting the premise that patients with poor outcomes are more likely to have comorbidities than patients with resolution of laryngotracheal symptoms (P = .034). CONCLUSIONS: Audio-video recording of pediatric laryngotracheal obstruction offers numerous advantages. Children classified into an array of diagnostic categories usually have favorable outcomes, but opportunities for continued advances exist, particularly regarding management of comorbidity and chronic obstruction.

Original languageEnglish (US)
Pages (from-to)1059-1070
Number of pages12
JournalLaryngoscope
Volume116
Issue number7
DOIs
StatePublished - Jul 2006

Fingerprint

Respiratory Sounds
Pediatrics
Comorbidity
Laryngoscopy
Laryngomalacia
Tracheomalacia
Laryngostenosis
Laryngitis
Video Recording
Granulation Tissue
Vocal Cords
Airway Obstruction
Foreign Bodies
Documentation
Survivors

Keywords

  • Airway
  • Audio-video
  • Flexible fiberoptic laryngoscopy
  • Laryngotracheal obstruction
  • Pediatric
  • Stridor

ASJC Scopus subject areas

  • Otorhinolaryngology

Cite this

Pediatric laryngotracheal obstruction : Current perspectives on stridor. / Bent, John P.

In: Laryngoscope, Vol. 116, No. 7, 07.2006, p. 1059-1070.

Research output: Contribution to journalArticle

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abstract = "OBJECTIVES/HYPOTHESIS: To assess how medical advances have impacted the diagnosis, management, and outcomes of pediatric laryngotracheal obstruction, and to describe the advantages of audio-video documentation of stridorous children. STUDY DESIGN AND METHODS: Retrospective. METHODS AND MATERIALS: 268 patients were referred for suspected laryngotracheal obstruction during the 30 months between September 1, 1995 and March 1, 1998: 173 had 206 flexible fiberoptic laryngoscopies, and 160 had 273 direct laryngoscopies. One hundred and forty-one children were identified with laryngotracheal obstruction, yielding 40 different diagnoses that could be classified into 9 major categories. Thirty-six children (25.5{\%}) had multiple sites of upper airway obstruction. RESULTS: 138 children had follow-up >1 month. Twelve children died (8.7{\%}), leaving 126 survivors (mean follow-up = 21.1 months). Outcomes were classified as resolved (44.2{\%}), improved (37.0{\%}), stable (9.4{\%}), failed (0.7{\%}), or death (8.7{\%}). Better outcomes were seen in more readily treated diagnostic categories, such as tracheobronchial foreign body, chronic laryngitis, and suprastomal granulation tissue; laryngeal stenosis, tracheomalacia, and recurrent respiratory papillomatosis, had less favorable outcomes (P <.001). The former group also showed superior outcome compared to laryngomalacia (P <.001) and vocal cord mobility disorders (P = .004). Ninety-four patients (68.1{\%}) had comorbidities complicating their management. Comorbid conditions were universal among deceased patients and least common in the resolved outcomes category (56.7{\%}), supporting the premise that patients with poor outcomes are more likely to have comorbidities than patients with resolution of laryngotracheal symptoms (P = .034). CONCLUSIONS: Audio-video recording of pediatric laryngotracheal obstruction offers numerous advantages. Children classified into an array of diagnostic categories usually have favorable outcomes, but opportunities for continued advances exist, particularly regarding management of comorbidity and chronic obstruction.",
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