gms | German Medical Science

Introduction: Stridor in neonates and toddlers is a common symptom to raise concern among parents and physicians. Usually, the standard approach is watchful waiting based on the expectation of self-limiting laryngomalacia. However, diagnostic microlaryngobronchoscopy (MLB) may reveal various pathology, which may require surgical treatment.

Methods: We retrospectively reviewed medical records and video documentation of endoscopies of all patients below the age of 2 years, who presented with noisy breathing as their chief complaint and subsequently underwent MLB between 2010 and 2016.

Results: Eighteen patients - 13 (72.2%) males, 5 (27.7%) females, mean age 4.0±5.4 months, range 1 day to 1.78 years - were subjected to MLB for stridorous breathing. The most common cause of stridor was laryngomalacia, observed in 8 (44.4%) of the patients, followed by vocal cord paralysis in 2 (11.1%). One (5.5%) patient had hyperplastic tonsils, 1 (5.5%) had tracheal stenosis, 1 (5.5%) subglottic hemangioma, 1 (5.5%) vallecular cyst, and 1 (5.5%) an aberrant interarytenoid mucosal fold. In 2 (11.1%) occasions, the stridor was due to macroglossia combined with either microretrognathia or choanal atresia. Just 1 (5.5%) of the endoscopies was inconclusive. A total of 8 patients (44.4%) followed surgical treatment: 4 (50%) of the children with laryngomalacia required supraglottoplasty and 4 (40%) of the other children required other surgical interventions of the upper airways.

Conclusions: Our results show an important proportion of upper airway conditions, which require a surgical intervention in stridorous infants. Watchful waiting can not be advocated in such children before evaluating them with MLB.

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