Abstract â–¡ 170

Obstruction of the airway in infants and children is characterized by inspiratory stridor, dyspnea, and thoracic indrawings. The history and the type of the stridor usually give an indication where the obstruction is to be found, so that the further evaluation can be fairly limited. In newborns the symptoms are less specific: cyanosis, bradycardia, respiratory arrest, feeding problems, and not always stridor. This group of patients need a more extensive evaluation: cardiologic, metabolic, neurologic examinations and an evaluation of the complete airway.

Examination includes inspection of the face and cranium. Craniofacial malformation with deformity of the skull base, midface underdevelopment, or micrognathia often is accompanied by airway obstruction. Patency of the nose is easily checked by watching the fogging of a mirror held under the nostrils, or by blowing air through the nose with a balloon. A CT-scan is very helpful in defining nasal obstruction. Fiberoptic endoscopy in an awake patient is useful to diagnose nasal obstruction, such as dacryocystocele, choanal atresia, laryngomalacia, or vocal cord paralysis in newborns, and collapse at the level of the oropharynx (Obstructive Sleep Apnea Syndrome, OSAS). In most cases rigid (and flexible) endoscopy under general anesthesia is needed to inspect the complete airway from nose to bronchial tree. With this technique nearly all causes of airway obstruction can be diagnosed. Disorders which are more difficult to diagnose endoscopically are OSAS, gastro-esophageal reflux disease (GERD), and recurrent croup. Polysomnography has become indispensable in the diagnosis of OSAS, in determining the severity of the obstruction, and in the evaluation of the therapy. Edema and redness of the posterior part of the laryngeal entrance are rather aspecific symptoms of GERD. Other types of investigation are needed to establish the diagnosis: endoscopy of the esophagus, X-ray of the esophagus, and most importantly pH monitoring of the lower esophagus and the hypopharynx. However we still have no generally accepted definition of pathologic values of hypopharyngeal pH. Endoscopy of the airway in patients with recurrent croup rarely reveals a cause (f.e. a moderate subglottic stenosis) for the disease. There are indications that allergy and hyperreactivity may play a role. Laboratory investigation for these conditions might be more advisable than endoscopy alone.