Division of Otolaryngology, Department of Surgery, Texas Children's Hospital, Baylor College of Medicine, 6621 Fannin St, Houston, TX 77030, USA.
Division of Otolaryngology, Department of Surgery, Texas Children's Hospital, Baylor College of Medicine, 6621 Fannin St, Houston, TX 77030, USA.
Auris Nasus Larynx. 2024 Feb;51(1):125-131. doi: 10.1016/j.anl.2023.07.005. Epub 2023 Aug 6.
To determine the utility of triple endoscopy (combined direct laryngoscopy, bronchoscopy (DLB), flexible bronchoscopy with bronchoalveolar lavage (FB + BAL), and esophagogastroduodenoscopy (EGD)) in the diagnosis and management of patients with recurrent croup (RC), and to identify predictors of endoscopic findings METHODS: A retrospective chart review was performed of pediatric patients (age <18 years) with RC evaluated by triple endoscopy at a tertiary care pediatric hospital from 2010 to 2021. Data including presenting symptoms, airway findings, BAL and EGD with biopsy findings were collected.
42 patients with RC underwent triple endoscopy were included. The mean age was 4.55±2.84 years old. The most common symptom was chronic cough among 19 (45%) patients, while 23 (55%) patients had gastrointestinal (GI) symptoms. Airway findings included tracheomalacia in 19, laryngeal cleft in 17, and subglottic stenosis in 11 patients. On EGD with biopsy, abnormal gross findings were present in 6 and abnormal microscopic findings in 18 patients, including 6 with histologic findings suggestive of gastroesophageal reflux and 5 with eosinophilic esophagitis. Seventeen (40%) patients had positive culture on BAL. No findings in patient histories significantly predicted presence of lower airway malacia, subglottic stenosis, or abnormal EGD findings.
Children with recurrent croup presenting to aerodigestive centers may not have any pertinent presenting symptoms that correlate with significant findings on triple endoscopy. Further work is needed to determine which children with recurrent croup may benefit from aerodigestive evaluation.
Level 3.
确定三联内镜（联合直接喉镜检查、支气管镜检查（DLB）、支气管肺泡灌洗（FB + BAL）联合纤维支气管镜检查和食管胃十二指肠镜检查（EGD））在复发性喉炎（RC）患者的诊断和治疗中的作用，并确定内镜检查结果的预测因素。
对 2010 年至 2021 年在一家三级儿科医院接受三联内镜检查的小儿（<18 岁）RC 患者进行回顾性图表审查。收集的数据包括患者的主要症状、气道检查、支气管肺泡灌洗和活检的发现。
共纳入 42 例 RC 患者进行三联内镜检查。平均年龄为 4.55±2.84 岁。最常见的症状是 19 例（45%）患者慢性咳嗽，而 23 例（55%）患者有胃肠道（GI）症状。气道检查发现 19 例气管软化，17 例喉裂，11 例声门下狭窄。在 EGD 活检中，6 例存在异常大体表现，18 例存在异常显微镜表现，包括 6 例有提示胃食管反流的组织学表现和 5 例嗜酸细胞性食管炎。17 例（40%）患者支气管肺泡灌洗液培养阳性。患者病史中没有任何发现明显预测下气道软化、声门下狭窄或异常 EGD 发现的存在。
出现呼吸道和消化道症状的复发性喉炎患儿可能没有任何与三联内镜检查重要发现相关的相关症状。需要进一步研究哪些复发性喉炎患儿可能受益于呼吸道和消化道评估。
3 级。
