Outpatient fibre-optic laryngoscopy for stridor in children and infants

Many neonates are referred for a diagnosis with stridor. The gold standard investigation has traditionally been a rigid or direct microlaryngoscopy. This impacts on existing theatre schedules, demands a high level of skills from the paediatric anaesthetist along with the risk of exposing a neonate to a general anaesthetic. A bed in paediatric intensive care is often required and must be reserved. As laryngomalacia is the most common diagnosis and less serious than the investigations for infants with stridor themselves, clinicians have been looking to use the flexible fibre-optic laryngoscope to view the upper airway in awake neonatal patients. We present our experience in 66 neonatal patients initially managed by awake per-oral flexible fibre-optic laryngoscopy for stridor. We conclude that the technique is safe, straightforward and allows a diagnosis to be achieved in a significant number of cases. We recommend it as a first line investigation, reserving microlaryngoscopy for the group of patients in whom a diagnosis cannot be made in the outpatient clinic.