Diagnosis of recurrent intermittent airway obstruction ("recurrent croup") in children

Children with a history of recurrent intermittent airway obstruction can present with a constellation of signs and symptoms labeled by their primary care physician as "recurrent croup." Recurrent croup, however, is not a diagnosis and should alert the clinician to the potential for intrinsic or extrinsic laryngotracheal pathology. This study was undertaken to evaluate referral patterns, diagnostic algorithms, and diagnoses for children with a history of recurrent intermittent airway obstruction initially characterized as "recurrent croup." We performed a retrospective analysis of office and operative records of children with a history of recurrent intermittent airway obstruction characterized as "recurrent croup." The setting was a university-based pediatric otolaryngology practice with both urban and suburban referral patterns. The medical records of 53 children (median age, 2 years) with a history of mild to severe recurrent intermittent airway obstruction characterized as "recurrent croup" were evaluated with respect to referral source, duration of signs and symptoms, diagnostic algorithm, and findings. We conclude that recurrent intermittent airway obstruction in children is an underappreciated clinical scenario. Upper aerodigestive tract endoscopy is a key component in a diagnostic evaluation to ascertain the cause. The decision for an endoscopic evaluation is best determined after analysis of the patient's age, past medical history, clinical severity, and suspected diagnosis. By virtue of his or her knowledge of aerodigestive tract anatomy and endoscopy skills, the otolaryngologist can take a proactive role in arriving at an accurate diagnosis in these children.