Related Experiment Video
Updated: Apr 6, 2026
Minimally Invasive Murine Laryngoscopy for Close-Up Imaging of Laryngeal Motion During Breathing and Swallowing
Published on: December 1, 2023
Quantitative assessment of the upper airway in infants and children with subglottic stenosis
Carlton Zdanski1, Stephanie Davis2, Yi Hong3
1Department of Otolaryngology/Head and Neck Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
Insights
Quantitative geometric and computational fluid dynamic (CFD) measures from medical imaging effectively identified children with subglottic stenosis (SGS) needing surgery. These airway assessments offer objective thresholds for treatment planning in pediatric SGS.
Area of Science:
- Pediatric Otolaryngology
- Medical Imaging Analysis
- Computational Fluid Dynamics
Background:
- Subglottic stenosis (SGS) in children presents diagnostic and treatment planning challenges.
- Objective measures are needed to guide surgical intervention decisions for pediatric SGS.
Purpose of the Study:
- To evaluate the efficacy of quantitative geometric and computational fluid dynamic (CFD) models derived from medical imaging.
- To determine if these models can serve as diagnostic and treatment planning tools for pediatric SGS.
Main Methods:
- Retrospective review of computed tomography (CT) scans (n=17) and polysomnograms (n=15) from children with SGS.
- Analysis of geometric and CFD measures, compared to a normal airway atlas.
- Statistical analysis using t-tests with Bonferroni correction and area under the curve analysis.
Main Results:
- Two geometric indices and one CFD measure significantly differentiated children with SGS who underwent surgery.
- Optimal cutoffs for these quantitative measures were established.
- Polysomnography measures showed significance only before correction, highlighting the value of imaging-based assessments.
Conclusions:
- Geometric and CFD variables derived from CT imaging are sensitive indicators for surgical intervention in pediatric SGS.
- This study provides preliminary objective thresholds for surgical versus non-surgical treatment decisions.
- Further research is needed to validate these findings and refine treatment recommendations.
Objectives/Hypothesis:
Determine whether quantitative geometric measures and a computational fluid dynamic (CFD) model derived from medical imaging of children with subglottic stenosis (SGS) can be effective diagnostic and treatment planning tools.
Study Design:
Retrospective chart and imaging review in a tertiary care hospital.
Methods:
Computed tomography scans (n = 17) of children with SGS were analyzed by geometric and CFD methods. Polysomnograms (n = 15) were also analyzed. Radiographic data were age/weight flow normalized and were compared to an atlas created from radiographically normal airways. Five geometric, seven CFD, and five polysomnography measures were analyzed. Statistical analysis utilized a two-sample t test with Bonferroni correction and area under the curve analysis.
Results:
Two geometric indices (the ratio of the subglottic to midtracheal airway, the percent relative reduction of the subglottic airway) and one CFD measure (the percent relative reduction of the hydraulic diameter of the subglottic airway) were significant for determining which children with SGS received surgical intervention. Optimal cutoffs for these values were determined. Polysomnography, the respiratory effort-related arousals index, was significant only prior to Bonferroni correction for determining which children received surgical intervention.
Conclusions:
Geometric and CFD variables were sensitive at determining which patients with SGS received surgical intervention. Discrete quantitative assessment of the pediatric airway was performed, yielding preliminary data regarding possible objective thresholds for surgical versus nonsurgical treatment of disease. This study is limited by its small, retrospective, single-institution nature. Further studies to validate these findings and possibly optimize treatment threshold recommendations are warranted.
Level Of Evidence:
4 Laryngoscope, 126:1225-1231, 2016.
Related Concept Videos
01:30Assessment of Airway, Skin Color, and Use of Accessory Muscles
Introduction
The initial evaluation of a patient's respiratory system...
01:28Physical Assessment of the Respiratory Tract IV: Auscultation
Breath Sounds
Breath sounds are categorized into vesicular, bronchovesicular, and bronchial.
01:30Cardiopulmonary Resuscitation V: Advanced Airway Management Techniques
01:29Assessment of Ventilation II: Respiratory Depth and Rhythm
Respiratory depth measures the volume of air inhaled or exhaled during a breath. It can vary from shallow to deep and typically remains consistent when a person is at rest or asleep. Occasionally, individuals will automatically inhale deeply, known as sighing, which inflates the lungs with more air than normal breathing.
To assess respiratory depth, observe the degree of chest excursion or movement:
01:28Physical Assessment of the Respiratory Tract I: Health History
Subjective Data
Subjective data provides vital information about the patient's health history and symptoms. This data is typically collected through interviews in which patients describe their experiences, symptoms, and concerns.
Health history and...
01:20Assessment of Ventilation I: Respiratory Rate
A Ventilation assessment is critical for monitoring a patient's health status. Respiration, one of the most accessible vital signs, provides insights into the function of numerous body systems and can indicate serious health issues, such as brainstem injuries from head trauma.
Critical Guidelines for Assessing Ventilation: