Evaluation of pediatric upper airway diseases with rigid telescope video laryngoscopy

Abstract

INTRODUCTION: It is hard to make a differential diagnosis of upper airway diseases in pediatrics. Best method is direct visualization. Flexible nasopharyngoscopy is the most performed method. Rigid telescope-video laryngoscopy (RTVL) could be an alternative in patients who can not be performed flexible nasopharyngoscopy. It is aimed to review RTVL results of pediatric patients for the evaluation of upper airway problems. METHODS: A retrospective analysis of patients who underwent RTVL because of upper airway problems were conducted in the study. The patients’ symptoms, additional diseases and examination findings were recorded. The examinations were performed with a 30 degree rigid telescope – video laryngoscopy by a same, experienced physician. The procedures were performed when flexible video nasopharyngolaryngoscopy was unsuccesfull or when any kind of surgical intervention was planned. Examination findings as well as the surgical procedures performed were recorded. RESULTS: Total of 427 procedures were performed to 332 patients. Stridor was the most common indication for the procedure. The most common examination finding was laryngomalacia. There were 73 patients who had extubation failure and were applied rigid telescope – video laryngoscopy for this reason. Fifty-nine patients had intubation granuloma and this was the most common finding in patients with extubation failure. Tracheotomy was applied to 67 patients. The most common indication for tracheotomy was prolonged intubation. One patient experienced bradycardia during all procedures who recovered with appropriate intervention. DISCUSSION and CONCLUSION: Stridor and prolonged intubation were the most common symptoms of pediatric upper airway diseases. Laryngomalacia with or without gastro-esophageal reflux were the most common causes. Rigid telescope – video laryngoscopy may be a useful method to evaluate pediatric upper airway diseases when flexible laryngoscopy can not be performed.