Sleep Fluoroscopy for Localization of Upper Airway Obstruction in Children

1996 ◽  
Vol 105 (9) ◽  
pp. 678-683 ◽  
Author(s):  
Sharon E. Gibson ◽  
Janet L. Strife ◽  
Charles M. Myer ◽  
David M. O'Connor
Keyword(s):  
Airway Obstruction ◽  
Upper Airway ◽  
Endoscopic Examination ◽  
Upper Airway Obstruction ◽  
Pediatric Airway ◽  
Valuable Adjunct ◽  
Neuromuscular Abnormalities ◽  
Multiple Levels ◽  
A Site ◽  
Airway Abnormalities

The management of children with upper airway obstruction (UAO) in whom previous airway surgeries or concomitant craniofacial or neuromuscular abnormalities exist is complicated by potential obstruction at multiple sites. Sleep fluoroscopy (SF) provides adynamic representation of relative degrees of obstruction at multiple levels of the pediatric airway. Fifty-five SF studies were performed on 50 infants and children to localize obstructive sites. Correlation was assessed with findings on direct laryngoscopy and bronchoscopy under spontaneous ventilation. In 24 (44%), endoscopic and SF findings correlated exactly. The SF studies identified a site of UAO in 11 patients with normal findings on endoscopic examination and multiple sites of UAO in 16 others. Two thirds of these occurred at the hypopharynx and tongue base. The SF studies failed to detect 5 airway abnormalities in 4 patients. The sensitivity of SF for endoscopically verified laryngotracheal lesions was lowest for glottic (67%) and subglottic (70%) locations and higher for tracheal (92%) and supraglottic (100%) sites. Sleep fluoroscopy altered the course of treatment in 26 (52%) children. It appears to be a valuable adjunct to endoscopy in the identification and management of pediatric UAO when hypopharyngeal collapse or multiple levels of obstruction are suspected.

Is sleep nasendoscopy a valuable adjunct to clinical examination in the evaluation of upper airway obstruction?

2008 ◽  
Vol 266 (5) ◽  
pp. 691-697 ◽  
Author(s):  
Richard J. D. Hewitt ◽  
Arjun Dasgupta ◽  
Arvind Singh ◽  
Chirajit Dutta ◽  
Bhik T. Kotecha
Keyword(s):  
Airway Obstruction ◽  
Clinical Examination ◽  
Upper Airway ◽  
Upper Airway Obstruction ◽  
Valuable Adjunct ◽  
Sleep Nasendoscopy

The Aerodigestive Clinic: Multidisciplinary Management of Pediatric Dysphagia

2008 ◽  
Vol 17 (3) ◽  
pp. 101-109 ◽  
Author(s):  
Laura Haibeck ◽  
David L. Mandell
Keyword(s):  
Young Children ◽  
Airway Obstruction ◽  
Multidisciplinary Approach ◽  
Laryngopharyngeal Reflux ◽  
Upper Airway ◽  
Upper Airway Obstruction ◽  
Pediatric Airway ◽  
Common Causes ◽  
The Individual ◽  
The Relationship

Abstract The purposes of this article are (a) to explore the relationship between pediatric upper airway obstruction and dysphagia and (b) to highlight the benefits of using a multidisciplinary approach when assessing infants and children with upper respiratory and swallowing disorders. The functions of breathing and swallowing are tightly coordinated in infants and young children, and pediatric upper airway disorders can often adversely affect the swallowing mechanism and may even predispose the individual to aspiration. Some of the more common causes of pediatric airway obstruction seen in this setting are laryngomalacia, vocal fold paralysis, laryngeal cleft, and Pierre Robin's sequence. In the setting of all of these disorders, associations may also exist with gastroesophageal reflux (GER) and laryngopharyngeal reflux, and this topic is also reviewed. In the multidisciplinary assessment of young children with aerodigestive disorders, fiberoptic flexible endoscopic evaluation of swallowing has gained traction as a useful test for simultaneous evaluation of pediatric upper airway obstruction and dysphagia and has provided complimentary information to the more traditional pediatric videofluoroscopic swallowing evaluation. A representative case study is provided that illustrates the relationship between pediatric upper airway obstruction and dysphagia and demonstrates the effectiveness of a multidisciplinary approach.

Management of Difficult Airway Problems with Percutaneous Transtracheal Ventilation

1987 ◽  
Vol 96 (1) ◽  
pp. 34-37 ◽  
Author(s):  
Ernest A. Weymuller ◽  
Donald Paugh ◽  
Edward G. Pavlin ◽  
Charles W. Cummings
Keyword(s):  
Airway Obstruction ◽  
Upper Airway ◽  
Upper Airway Obstruction ◽  
Anesthetic Techniques ◽  
Tumor Surgery ◽  
Jet Ventilation ◽  
Neck Trauma ◽  
Potential Problems ◽  
Airway Problem ◽  
Airway Abnormalities

Percutaneous transtracheal jet ventilation was used in the management of 13 cases of upper airway obstruction. Cases are subdivided according to the nature of the presenting airway problem. The first group had stable upper airway abnormalities; the second group presented as emergencies with rapidly evolving upper airway obstruction. This technique has two major advantages: 1) it provides rapid access to the airway during acute emergencies; and 2) it provides control of the airway where tissue distortion from head and neck trauma or tumor surgery makes standard anesthetic techniques difficult. Complications including catheter displacement, total expiratory obstruction, pneumothorax, and subcutaneous emphysema have been encountered. The authors conclude that percutaneous transtracheal jet ventilation is effective. However, potential problems exist and an in-depth understanding of the technique is necessary for its appropriate application and successful use.

scholarly journals Patterns of Upper Airway Obstruction on Drug-Induced Sleep Endoscopy in Patients with Sleep-Disordered Breathing with AHI <5

OTO Open ◽  
2017 ◽  
Vol 1 (3) ◽  
pp. 2473974X1772148
Author(s):  
Sam Spinowitz ◽  
Mimi Kim ◽  
Steven Y. Park
Keyword(s):  
Airway Obstruction ◽  
Sleep Disordered Breathing ◽  
Upper Airway ◽  
Upper Airway Obstruction ◽  
Apnea Hypopnea Index ◽  
Sleep Endoscopy ◽  
Drug Induced ◽  
Drug Induced Sleep Endoscopy ◽  
Multiple Levels ◽  
Disordered Breathing

Objective To describe the patterns of upper airway obstruction in patients with sleep-disordered breathing with apnea-hypopnea index (AHI) <5 using drug-induced sleep endoscopy (DISE). Study Design Retrospective study. Setting Tertiary care center. Subjects and Methods Inclusion of patients with sleep-disordered breathing with AHI <5 on polysomnography who underwent DISE. Patients <18 years of age were excluded. DISE findings were reported with the VOTEL classification system: the level of collapse was described as occurring at the velum, oropharynx, tongue base, epiglottis, and the lingual tonsils. The degree of collapse was reported as complete, partial, or none. The pattern of the obstruction was described as anteroposterior, lateral, or concentric when applicable. Results A total of 54 patients with sleep-disordered breathing with AHI <5 underwent DISE. Ages ranged from 19 to 65 years. DISE was performed alone in 7% (n = 4) of patients and in conjunction with surgery in 93% (n = 50) of patients. The velum was the most frequent site of upper airway obstruction (85%, n = 46), followed by base of tongue (63%, n = 34), epiglottis (39%, n = 21), lingual tonsils (35%, n = 19), and oropharynx (31%, n = 17). Eighty-three percent (n = 45) of patients had multiple levels of upper airway obstruction, and 15% (n = 8) had a single level of upper airway obstruction. Conclusion Patients with sleep-disordered breathing with AHI <5 have significant upper airway obstruction as seen on DISE. DISE findings indicate that a majority of these patients have multiple levels of upper airway obstruction, which can lead to significant symptoms.

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