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Eshaq M, Chun RE, Martin T, Link TR, Kerschner JE. Office-based lower airway endoscopy (OLAE) in pediatric patients: a high-value procedure. Int J Pediatr Otorhinolaryngol 2014; 78:489-92. [PMID: 24418184 DOI: 10.1016/j.ijporl.2013.12.026] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2013] [Revised: 12/17/2013] [Accepted: 12/17/2013] [Indexed: 11/19/2022]
Abstract
OBJECTIVES Office-based lower airway endoscopy (OLAE) is not a widespread practice in children due to concerns about its safety and efficacy. In 2003, we reported on OLAE in 105 children presenting with airway symptoms and found it both safe and effective as a diagnostic tool. The current study is a follow-up to the 2003 study that reports on an additional 122 pediatric patients who received OLAE with special attention to the safety and efficacy of the procedure. METHODS A retrospective review at a tertiary-quaternary pediatric institution of 122 consecutive pediatric patients in which an airway lesion, by history and initial physical exam, was determined to be present at the level of the supraglottic larynx to the carina. In all patients, airway endoscopy was performed in the office using flexible fiberoptic laryngoscopy (FFL) and the endoscope was passed beyond the glottis to assess the lower airway, including the subglottis, trachea, and carina. The diagnoses were recorded and the number of times each diagnosis was encountered as well as the percent of patients who had each diagnosis was calculated. All cases requiring operating room procedures for further diagnosis or therapy were assessed for office-based and operating room diagnostic agreement. The ease of performing the lower airway assessment and the ease with which the subglottis, trachea, and carina were visualized were graded. An assessment for complications was also performed. RESULTS There were no complications with OLAE in any of the 122 patients. The percent of patients rated as having good visualization of anatomic structures were: 97% for visualization of the subglottis, 98% for visualization of the trachea, and 92% for visualization of the carina. In 93% of the cases the procedure was easily performed. There was excellent correlation between OLAE and operative endoscopy. CONCLUSION OLAE continues to be a safe, efficacious, and cost-effective tool for the diagnosis of lower airway pathology in pediatric patients.
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Affiliation(s)
- Milad Eshaq
- Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI, 53226, United States
| | - Robert E Chun
- Division of Pediatric Otolaryngology, Children's Hospital of Wisconsin, 9000 W. Wisconsin Avenue, Milwaukee, WI, 53226, United States; Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI, 53226, United States; Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI, 53226, United States
| | - Timothy Martin
- Division of Pediatric Otolaryngology, Children's Hospital of Wisconsin, 9000 W. Wisconsin Avenue, Milwaukee, WI, 53226, United States; Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI, 53226, United States; Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI, 53226, United States
| | - T Roxanne Link
- Division of Pediatric Otolaryngology, Children's Hospital of Wisconsin, 9000 W. Wisconsin Avenue, Milwaukee, WI, 53226, United States; Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI, 53226, United States; Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI, 53226, United States
| | - Joseph E Kerschner
- Division of Pediatric Otolaryngology, Children's Hospital of Wisconsin, 9000 W. Wisconsin Avenue, Milwaukee, WI, 53226, United States; Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI, 53226, United States; Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI, 53226, United States.
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