Accuracy and safety of tracheoscopy for infants in a tertiary care clinic.

OBJECTIVE: To assess the diagnostic accuracy and safety of office-based tracheoscopy when combined with flexible fiberoptic laryngoscopy (FFLT). Flexible laryngoscopy on infants is routinely performed by otolaryngologists in the clinic. The addition of tracheoscopy may improve overall airway assessment but is rarely performed due to the suspected risk of airway compromise. DESIGN: A 6-year retrospective medical record review. SETTING: Tertiary care hospital. PATIENTS: Thirty-one infants younger than 1 year with complete data from preoperative FFLT and microlaryngoscopy and bronchoscopy (MLB) were examined. MAIN OUTCOME MEASURES: Results from 241 MLB procedures were reviewed. RESULTS: Laryngomalacia (LM) and tracheomalacia (TM) were identified more often by FFLT than by MLB. In particular, the detection rate for LM and TM by MLB, as seen preoperatively by FFLT, was 79% and 61%, respectively. Compared with FFLT, MLB accurately diagnosed the severity of LM and TM only 55% and 65%, respectively, of the time. Fiberoptic laryngoscopy revealed synchronous airway lesions in 62% of infants with LM, while MLB discovered synchronous airway lesions in 54%. Static airway lesions were more frequently diagnosed with MLB. No respiratory events occurred during FFLT. CONCLUSIONS: In an appropriate patient, FFLT is a safe and effective diagnostic tool for common infant tracheal and laryngeal abnormalities. Detection and characterization of dynamic airway lesions is better achieved by FFLT than by MLB.