Waters K A, Woo P, Mortelliti A J, Colton R
Department of Otolaryngology and Communication Sciences, SUNY Health Science Center, Syracuse, NY 13210, USA.
Otolaryngol Head Neck Surg. 1996 Apr;114(4):554-61. doi: 10.1016/S0194-59989670246-2.
Accurate diagnosis of upper airway abnormalities by flexible laryngoscopy in infants is hampered by rapid laryngeal motion and lack of patient cooperation. This study evaluates the added role of videorecorded flexible laryngoscopy and the objective measurement of vocal fold abduction in improving the diagnosis of upper airway abnormalities in infants. Seventy-eight infants had videorecorded flexible laryngoscopy performed as part of their evaluation of a suspected airway disorder. These recordings were reviewed by three otolaryngologists for confirmation of the clinical diagnosis. From the video image, the maximum angle of vocal fold abduction was measured with image analysis software. Of 78 patients 40 had supraglottic or glottic abnormalities, 9 had nasal or nasopharyngeal obstruction, 9 had subglottic abnormalities (diagnosed subsequent to videolaryngoscopy), and 15 patients had normal findings on examination. Of those with laryngeal abnormalities, laryngomalacia was the most common diagnosis (23 of 78). Vocal fold paralysis was present in 4 patients. A separate group (9 of 78) of patients was identified as having symmetric bilateral limitation of vocal fold abduction. Laryngeal dyskinesia was diagnosed in these 9 patients. The mean values of maximal vocal fold abduction were as follows: (1) normals, 59.5 degrees; (2) laryngomalacia, 57.0 degrees; (3) paralysis, 26.6 degrees; and (4) incomplete abduction with laryngeal dyskinesia, 27.6 degrees. Videolaryngoscopy is a valuable tool for documentation, parent education, and analysis of infant laryngeal abnormalities. Repeat viewing of the video examination and frame-by-frame analysis improve the diagnostic accuracy. Using this approach, we have calculated the anterior glottic abduction angle in the normal and abnormal infant larynx. In addition, we have identified a group of infants with incomplete abduction of the vocal folds that appears to be different from that found in vocal cord paralysis.
婴儿喉部快速运动以及缺乏患者配合，妨碍了通过柔性喉镜对其上气道异常进行准确诊断。本研究评估了视频记录的柔性喉镜检查的附加作用以及声带外展的客观测量在改善婴儿上气道异常诊断方面的作用。78名婴儿接受了视频记录的柔性喉镜检查，作为其疑似气道疾病评估的一部分。三名耳鼻喉科医生对这些记录进行了复查，以确认临床诊断。利用图像分析软件从视频图像中测量声带外展的最大角度。78例患者中，40例有声门上或声门异常，9例有鼻腔或鼻咽部阻塞，9例有声门下异常（在视频喉镜检查后确诊），15例检查结果正常。在有喉部异常的患者中，喉软化是最常见的诊断（78例中的23例）。4例患者存在声带麻痹。另外一组（78例中的9例）患者被确定为有声带外展对称性双侧受限。这9例患者被诊断为喉运动障碍。最大声带外展的平均值如下：（1）正常组，59.5度；（2）喉软化组，5
