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Upper airway bronchoscopic interpretation
Published in Don Hayes, Kara D. Meister, Pediatric Bronchoscopy for Clinicians, 2023
Anita Deshpande, Cherie A. Torres-Silva, Catherine K. Hart
Airway malacia, which includes laryngomalacia, tracheomalacia, and bronchomalacia, is a dynamic obstruction of the airways and is the most common congenital airway anomaly in children. Laryngomalacia is a condition in which supraglottic structures, including the aryepiglottic folds, the arytenoid, corniculate, or cuneiform cartilages, the epiglottis, or a combination of all the above, collapse into the larynx and obstruct airflow during inspiration (Video 4.1). Flexible bronchoscopy via a trans-nasal approach during spontaneous ventilation allows for thorough dynamic evaluation. Common findings include shortened aryepiglottic folds, an omega-shaped epiglottis, and redundant arytenoid mucosa that can prolapse into the larynx.17
Common paediatric ENT viva topics
Published in Joseph Manjaly, Peter Kullar, Advanced ENT Training, 2019
Benjamin Hartley, Richard J Hewitt
The aetiology is poorly understood; two common theories are the neurologic and cartilaginous theories. In the neurologic theory, there is sensorineuromotor dysfunction, reduced neuromuscular tone and laryngeal coordination. Gastroesophageal reflux may contribute to mucosal oedema and reduced laryngeal sensation. Increased work of breathing may in turn exacerbate reflux owing to negative intrathoracic pressure. In the cartilaginous theory, immature laryngeal cartilage offers insufficient mechanical resistance to collapse, causing collapse of the supraglottic structures on inspiration. The resulting mucosal trauma causes oedema, further worsening the stridor. This theory has not been supported by histopathology or the lack of laryngomalacia in premature babies and at birth. The commonest theory is now that laryngomalacia is a normal anatomical variant which is predisposed to collapse on inspiration until such time as the airway grows and the tissues mature.
Otorhinolaryngology
Published in Stephan Strobel, Lewis Spitz, Stephen D. Marks, Great Ormond Street Handbook of Paediatrics, 2019
Chris Jephson, C. Martin Bailey
Mild laryngomalacia can be observed and most cases will resolve by the age of 18–24 months. Those who show signs of failure to thrive should undergo endoscopic aryepiglottoplasty to trim the redundant supraglottic tissues.
Pediatric bronchoscopy: recent advances and clinical challenges
Published in Expert Review of Respiratory Medicine, 2021
P Goussard, P Pohunek, E Eber, F Midulla, G Di Mattia, M Merven, JT Janson
Many pediatric bronchoscopists successfully adopted these techniques [21]. Analgosedation (or conscious sedation) for pediatric bronchoscopy was mostly performed using fentanyl derivatives as the analgetic component and benzodiazepine, almost universally low-dose midazolam, as the sedative drug. This combination proved very useful in providing sufficient sedation while maintaining spontaneous breathing, excluding unwanted reflexes and even keeping some cooperation of the patient. In most cases also a sufficient anterograde amnesia was achieved. Conscious sedation has always to be combined with appropriate topical anesthesia. As in most of the pediatric flexible bronchoscopies the instruments are introduced through the nose, topical anesthesia of nasal cavity must be always properly applied to avoid any pain in this very sensitive area. Topical anesthesia must be also applied onto the larynx to prevent any undesired reflexes, such as coughing or laryngospasm. This, however, should only be done after properly evaluating the larynx, its stability, and motility, because topical anesthesia can decrease laryngeal stability and enhance signs of laryngomalacia. Depending on the reaction of the patient, some additional topical anesthesia can be applied also into the airways through the working channel of the flexible bronchoscope during the procedure.
Histopathology of laryngomalacia
Published in Acta Oto-Laryngologica, 2021
Richard Wei Chern Gan, Ali Moustafa, Kerry Turner, Lindsey Knight
The latest addition to the list of theories is that laryngomalacia is caused by an imbalance between the supply and demand of air in the lungs [18]. The larynx situated high in the neonate with less post-nasal space volume gives rise to less volume of air to supply the lungs [18]. This gives rise to a higher likelihood of a mismatch between that volume of air and the demand of air in the lungs causing a suction pressure and collapsing of the laryngeal structures [18]. As the child grows, the larynx descends giving rise to increased post-nasal space and oropharyngeal volume explaining the spontaneous resolution of symptoms [18].
Spectrum of upper airway pathology in children with Down syndrome in a single tertiary centre
Published in Acta Oto-Laryngologica, 2022
Mohammad Nasyatmuddin Yahya, Bee-See Goh, Fahrin Zara Mohammad Nasseri, Nor Azlin Kamal Nor, Wan Nurulhuda Wan Md Zin, Hasniah Abdul Latif
A total number of 91 patients were recruited in this study. The details of demographic and relations to UAO as shown in Table 1. There were various causes of upper airway pathology in DS children as depicted in Figure 1 and Table 2. The comorbidities of DS were shown in Table 3. This study showed laryngomalacia could occur earlier than two weeks old, which is not typical for laryngomalacia in non-syndromic children. One case was a preterm baby, while four cases were observed in term babies. Four of these cases had other pathologies associated with laryngomalacia, while one case showed only laryngomalacia was diagnosed.