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Updated: May 25, 2026

Systematic Bronchoscopy: the Four Landmarks Approach
Published on: June 23, 2023
Upper airway abnormalities detected in children using flexible bronchoscopy
Levent Midyat1, Erkan Çakır, Arif Kut
1Department of Pediatric Pulmonology, Sureyyapasa Chest Diseases and Thoracic Surgery Training and Investigation Hospital, Istanbul, Turkey. midyatlev@yahoo.com
Insights
Pediatric flexible bronchoscopy frequently reveals upper airway malacia disorders, which are the most common finding. Early diagnosis of these congenital and acquired abnormalities can prevent unnecessary long-term treatments for chronic respiratory issues in children.
Area of Science:
- Pediatric Pulmonology
- Airway Endoscopy
- Respiratory Distress
Background:
- Upper airway obstruction requires rapid anatomical evaluation to determine severity and respiratory distress.
- Airway endoscopy is crucial for both diagnosing and treating pediatric airway conditions.
Purpose of the Study:
- To document upper airway abnormalities detected during flexible bronchoscopy in pediatric patients.
- To analyze findings from two major Turkish pediatric pulmonology centers.
Main Methods:
- Retrospective analysis of 1076 pediatric cases with pulmonary/airway disease.
- Flexible bronchoscopy performed between 2007 and 2011.
Main Results:
- Upper airway malacia disorders were the most common finding (79.6%).
- Other frequent pathologies included laryngeal edema (12.9%), external tracheal compression (12.3%), and subglottic stenosis (4.0%).
- Symptom duration varied significantly by diagnosis, being shortest for vocal cord paralysis.
Conclusions:
- Congenital and acquired upper airway abnormalities, particularly malacia, should be considered in children with chronic respiratory problems.
- Prompt diagnosis allows for discontinuation of unnecessary long-term antibiotic or antiasthmatic therapies.
Objectives:
Rapid anatomical evaluation is essential to establish the severity of cases with upper respiratory obstruction and to define the degree of respiratory distress. Detailed airway endoscopy is required in most patients, not only for diagnosis, but also to treat the condition. In this study, as two of the largest paediatric pulmonology centres in Turkey, we reviewed the data of our bronchoscopy patients, and aimed to document the upper airway abnormalities that we detected during these procedures.
Patients And Methods:
A retrospective analysis was made of the records of 1076 paediatric cases with pulmonary/airway disease who had undergone flexible bronchoscopy between 2007 and 2011.
Results:
Upper airway malacia disorders were the most common (79.6%, n=259) bronchoscopic findings detected in the patients. The other most common pathologies were laryngeal edema (12.9%, n=42), external tracheal compression (12.3%, n=40), subglottic stenosis (4.0%, n=13), tracheal stenosis (2.8%, n=9), and vocal cord paralysis/irregularity (2.8%, n=9). The mean duration of symptoms was shortest in patients with vocal cord paralysis, and longest in patients with tracheal nodules (p<0.001).
Conclusion:
Paediatricians should keep in mind the possibility of malacia disorders and other congenital and acquired upper airway abnormalities in children with chronic respiratory problems. Diagnosis of underlying diseases, as soon as possible, permits the withdrawal of antibiotics or antiasthmatic drugs often used unnecessarily for long periods to treat these children.
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