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D. Richard Lindstrom III, MD; David T. Book, MD; Stephen F. Conley, MD; Valerie A. Flanary, MD; Joseph E. Kerschner, MD

Arch Otolaryngol Head Neck Surg. 2003;129:847-853.

Background  Office-based evaluation of the lower airway in adults with only topical anesthetics has been well documented. This study was performed to assess the feasibility of performing office-based lower airway endoscopy in a pediatric population.

Design  One hundred five consecutive pediatric patients requiring flexible laryngoscopy were studied. All received only a topical anesthetic-decongestant applied nasally. After flexible laryngoscopy, the endoscope was passed below the vocal folds to visualize the subglottis, trachea, and carina. All evaluations were videotaped for later review.

Setting  Academic pediatric otolaryngology practice.

Main Outcome Measures  All 105 patients were studied for complications and agreement between office endoscopy and operative endoscopy when necessary (performed in 20 patients). A subset of 24 consecutive patients were studied for ease of performing the lower airway evaluation, rated on a 3-point scale: 1, unable to perform; 2, performed with some difficulty; and 3, performed without difficulty. The ability to view the subglottis, trachea, and carina were also rated on a 3-point scale.

Results  There were no complications for any of the procedures. Office endoscopy correlated with operative endoscopy in all cases. In the subset of 24 patients, the mean score for ease of endoscopy was 2.83. The mean scores for visualizing the lower airway were 2.91 for the subglottis, 2.80 for the trachea, and 2.24 for the carina.

Conclusion  With the use of only topical anesthesia, flexible endoscopy of the lower airway in children can be performed in the office setting and can be used effectively to evaluate abnormalities of the lower airway.

From the Department of Otolaryngology and Communication Sciences (Drs Lindstrom, Book, Conley, Flanary, and Kerschner) and Division of Pediatric Otolaryngology (Drs Conley, Flanary, and Kerschner), Children's Hospital of Wisconsin, Medical College of Wisconsin, Milwaukee. The authors have no relevant financial interest in this article.