Pediatric Exercise Stress Laryngoscopy following Laryngotracheoplasty: A Comparative Review.

OBJECTIVE Exercise-induced airway obstruction in pediatric patients is a unique phenomenon with multiple potential etiologies. An accurate diagnosis can be challenging to establish in pediatric patients because they are frequently asymptomatic at rest. Exercise stress laryngoscopy (ESL) is a modality by which pediatric patients can be evaluated under physiologic conditions that produce their symptoms. The purpose of this study was to demonstrate (1) the diagnostic effectiveness of pediatric ESL and (2) the ability of ESL to guide treatment for "normal" and post-airway reconstruction patients with exercise intolerance. STUDY DESIGN Case series with chart review. SETTING Tertiary care children's hospital. SUBJECTS AND METHODS Patients undergoing ESL for exercise intolerance were reviewed. Demographics, surgical history, examination findings, and management recommendations were extracted. RESULTS Thirty-seven patients (average age, 13.5 years; range, 5-21 years) were included. There were 14 male and 23 female patients. Airway abnormalities became evident in 56% of patients. Of these, 24% had focal supraglottic collapse, 43% had evidence of paradoxical vocal fold motion, 24% had combined supraglottic and glottic dysfunction, and 9% had distal airway abnormalities. Overall, 18 patients had changes in management after ESL. Twelve patients in this review had histories of laryngotracheoplasty with equivocal findings on operative bronchoscopy. Of these patients, 10 (83%) received focal diagnoses after ESL. CONCLUSION ESL is a contemporary modality by which complex patients with undiagnosed exercise intolerance can be effectively evaluated. ESL can be an important tool used to guide treatment in pediatric patients with exercise-induced dyspnea after airway reconstruction.