Safety and efficacy of office-based transoral flexible laryngoscopy in infants.

INTRODUCTION The majority of children with stridor present in the first few months of life. Although awake nasopharyngolaryngoscopy, and direct laryngoscopy and bronchoscopy under anesthesia are the standard for evaluation of infants with significant airway obstruction, a substantial subset of infants present with milder symptoms. For them, flexible laryngoscopy in the office setting is safe and often sufficient to reach a correct diagnosis. Unfortunately, standard 4-mm office flexible laryngoscopes may be difficult or uncomfortable to pass transnasally in neonates or small infants. Ultraslim 2.4-mm flexible nasopharyngoscopes exist but are fragile and costly to maintain. We began using a transoral approach to flexible laryngoscopy for consultations in the newborn intensive care unit 20 years ago. When the technique proved safe in this controlled environment, we expanded its use to office examination of neonates and infants with mild stridor. This article describes the technique of transoral flexible laryngoscopy and the features of newborn anatomy and physiology that allow it. A 10-year consecutive case series is reviewed to define the advantages and limitations of transoral laryngoscopy in the outpatient setting.