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Airway evaluation in children

When assessing your child's airway and breathing difficulties, the doctor will want to know whether your baby was born on time, whether they needed Neonatal Intensive Care admission, whether the baby has any other health problems, and when the problems started. They will want to know about breathing, feeding and voice. In addition to asking about your experiences, the doctor will also want to know whether your baby is growing well (bring the red book with you and make sure the baby is weighed at least every 2 weeks if you are worried about breathing / feeding). Having a video of your child’s breathing on your mobile phone is often also helpful. 

 

Flexiscope examination in clinic

Depending on your baby's age, the ENT Doctor may examine your baby’s larynx and breathing passages in clinic. This is done with a tiny camera attached on the end of a flexible tube. The instrument is called a flexiscope. It can be inserted either via the nose or the mouth, and passed down towards the voice box. Your baby won’t like having it done: the examination is uncomfortable, but not to a great degree. It’s worth putting up with the discomfort, as often a flexiscope airway evaluation is all that is required for your ENT specialist to know the diagnosis. Sometimes the examination can make babies vomit, so if possible try to make sure that the baby has not had a feed for a couple of hours before the examination.

Flexiscope examination in clinic is only possible if you have a baby that can be gently held still and comforted by the parents, or if you have an older cooperative child. In babies it is often possible up to about 1 year of age, but toddlers are usually too distressed and strong to allow us to perform this in clinic.

 

Laryngotracheobronchoscopy / microlaryngobronchoscopy

If the doctor is concerned that flexiscope examination won’t be able to give the diagnosis, or the child’s symptoms are severe, or the child unable to tolerate examination in clinic,  then an airway examination in theatre may be suggested. This is called a microlaryngobronchoscopy or laryngotracheobronchoscopy. The procedure requires the child to be asleep under general anaesthetic in the operating theatre, unlike flexiscope in clinic where the child is awake. So an examination in theatre is more complex, but it allows the surgeon to see more, get a better view, and perform procedures to help breathing. 

Flexiscope used to examine the voice box in clinic

Ventilating bronchoscope used to examine the airway in theatre

Hopkins rod lens telescope used to examine the airway in theatre

Normal Larynx

Section contributor:

Quentin Bounduelle MRCS DOHNS

Core Surgery Doctor