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David T. Rudman, MD; Charles A. Elmaraghy, MD; William E. Shiels, DO; Gregory J. Wiet, MD

Arch Otolaryngol Head Neck Surg. 2003;129:305-309.

Objective  To determine the role of airway fluoroscopy in comparison with other diagnostic modalities in diagnosing the site of partial airway obstruction in children with stridor.

Design  Prospective study comparing direct laryngoscopy and bronchoscopy with nasopharyngoscopy, airway fluoroscopy, and plain films. Children with stridor or partial airway obstruction were evaluated by the Department of Otolaryngology at Columbus Children's Hospital, Columbus, Ohio. A history review and physical examination, including flexible fiberoptic laryngoscopy, plain films, airway fluoroscopy, and direct laryngoscopy and bronchoscopy, were performed for all children.

Setting  Tertiary care children's hospital.

Patients  From November 1996 to September 1999, 64 children aged 1 week to 12 years, with a mean age of 1.8 years and male-female ratio of 3:2, were evaluated for stridor.

Main Outcome Measures  The sensitivity and specificity of airway fluoroscopy in diagnosing the site of partial airway obstruction in comparison with nasopharyngoscopy and plain films.

Results  Airway fluoroscopy had a sensitivity of 80% for subglottic, 73% for tracheal, and 80% for bronchial sites of obstruction. It was less sensitive for supraglottic and glottic sites—33% and 14%, respectively. Nasopharyngoscopy was more sensitive for supraglottic and glottic sites of obstruction. Overall, airway fluoroscopy was far more sensitive than plain films for diagnosing site of obstruction.

Conclusions  Airway fluoroscopy is a quick, noninvasive, and dynamic study of the entire airway that provides important additional information to the history review and physical examination and is a valuable adjunct to flexible fiberoptic laryngoscopy. It was far superior to plain films and may serve as a cost-effective screening tool in the evaluation of stridor in children, especially for lesions of the lower airway.

From the Division of Pediatric Otolaryngology, Department of Otolaryngology (Drs Rudman, Elmaraghy, and Wiet) and the Department of Radiology (Dr Shiels), Columbus Children's Hospital, The Ohio State University College of Medicine and Public Health, Columbus.

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