Inspiratory stridor of newborns and infants admitted to a paediatric ENT outpatient clinic: diagnostic approach and ther
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ORIGINAL ARTICLE
Inspiratory stridor of newborns and infants admitted to a paediatric ENT outpatient clinic: diagnostic approach and therapeutic outcome Eric Moreddu 1
&
Maeva Montero 2 & Laurent Gilain 2 & Jean-Michel Triglia 1 & Richard Nicollas 1
Received: 4 September 2020 / Revised: 21 October 2020 / Accepted: 26 October 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract The main objective was to analyse the use of rigid laryngotracheoscopy under general anaesthesia (GA) and endoscopic surgery in the management of inspiratory stridor in patients referred to a paediatric ENT outpatient clinic. The secondary objective was to analyse the aetiological diagnoses made and their therapeutic management. This is a prospective study including all newborns and infants, corresponding to 190 patients, presenting for the first time in consultation for inspiratory stridor from January 2015 to December 2017. A consultation form was filled out after each consultation and added to a database; a management algorithm was used to determine which patients required a rigid laryngotracheoscopy. A 17.9% (n = 34) of the patients required rigid laryngotracheoscopy, of whom 12.6% (n = 24) underwent concomitant endoscopic surgery. A 65.8% (n = 125) of the patients were diagnosed with laryngomalacia, 21.1% (n = 40) with isolated posterior excess of mucosa, 9.5% (n = 18) with another diagnosis and 3.7% (n = 7) with a normal examination. The presence of comorbidity was associated (p < 0.001) with the use of rigid laryngotracheoscopy and endoscopic surgery. Conclusion: Rigid laryngotracheoscopy under GA was required in one in five to six patients. Conservative management with strict follow-up may be appropriate in a large number of patients, especially those with laryngomalacia. What is Known: • Previous research has established that laryngomalacia is the main aetiology of stridor. • Comorbidities are linked with a poor tolerance of stridor. What is new: • About one in five to six patients seen in consultation for stridor will require a trip to the operative room (and one in eight will require endoscopic surgery). • Laryngomalacia and isolated posterior excess of mucosa account for 85–90% of the patients seen in consultation for stridor.
Keywords Respiratory distress . Laryngotracheoscopy . Laryngomalacia . Laryngopharyngeal reflux . Paediatric . Endoscopy
Abbreviations ENT Ear, nose throat GA General anaesthesia PPI Proton pump inhibitor
Introduction In English terminology, stridor is a harsh respiratory sound caused by turbulent airflow through a restricted area, with
Communicated by Peter de Winter * Eric Moreddu [email protected] Maeva Montero [email protected] Laurent Gilain [email protected] Jean-Michel Triglia [email protected]
Richard Nicollas [email protected] 1
Paediatric Otorhinolaryngology, Head and Neck Surgery Department, La Timone Children’s Hospital, Aix–Marseille University, 264 rue Saint Pierre, 13385 Marseille Cedex 5, France
2
Otorhinolaryngology
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