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Diagnosis and management of postcricoid cushion in infants: A single-center experience
Xiaowei Chen1, Feizhou Zhang2, Li Yang3
1Department of Otorhinolaryngology, The Children's Hospital, Zhejiang University School of Medicine, Hangzhou, 310052, China; National Clinical Research Center for Child Health, Hangzhou, 310052, China.
Insights
Postcricoid lesions in children, often presenting as laryngeal stridor, require careful diagnosis. Laryngoscopy is key, as imaging and propranolol treatment are often ineffective for these posterior cricoid area abnormalities.
Area of Science:
- Pediatric Otolaryngology
- Pediatric Pulmonology
- Pediatric Gastroenterology
Background:
- Postcricoid lesions in children involve the posterior cricoid area, impacting respiratory and swallowing functions.
- These conditions predominantly affect infants and preschool-aged children.
Purpose of the Study:
- To analyze the clinical features, diagnosis, treatment, and prognosis of pediatric postcricoid cushion cases.
- To evaluate the effectiveness of diagnostic and therapeutic modalities for postcricoid lesions in children.
Main Methods:
- Retrospective analysis of 33 pediatric cases diagnosed with postcricoid cushion from June 2020 to June 2025.
- Review of clinical manifestations, diagnostic imaging (CT angiography, MRI), and treatment outcomes.
- Correlation of laryngoscopy findings with imaging results and therapeutic responses.
Main Results:
- Laryngeal stridor and abnormal throat sounds were the most common presenting symptoms in 33 pediatric cases.
- Posterior pharyngeal wall soft tissue thickening was a frequent finding on CT angiography and MRI.
- Laryngomalacia was the most prevalent comorbid laryngeal abnormality; propranolol showed no significant therapeutic effect in 10 treated cases.
Conclusions:
- The postcricoid cushion, though a normal anatomical entity, necessitates increased pediatrician awareness.
- Laryngoscopy is crucial for definitive diagnosis of postcricoid lesions, often rendering specific interventions unnecessary.
- The ineffectiveness of empirical beta-blocker therapy highlights the need for revised diagnostic strategies to prevent misdiagnosis.
Objective:
Postcricoid lesions in children encompass a diverse range of pathological alterations in the posterior cricoid area, involving the posterior pharyngeal wall, postcricoid mucosa, and adjacent soft tissues. These lesions can notably affect respiratory and swallowing functions, predominantly affecting infants and preschool-aged children.
Methods:
A retrospective analysis was carried out on the clinical manifestations, diagnosis, treatment modalities, and prognosis of children diagnosed with postcricoid cushion admitted to our hospital from June 2020 to June 2025.
Results:
Over a five-year period, our center managed 33 cases of children with postcricoid cushion. Among them, 23 cases were male (23/33) and 10 cases were female (10/33). The youngest patient was diagnosed immediately after birth, while the oldest was 4 years old, with a median age of 6.84 months. Laryngeal stridor and abnormal throat sounds were the primary reasons for patients seeking medical attention, with only two patients reporting feeding difficulties and milk choking. 10 cases underwent neck CT angiography (CTA) and 8 cases had magnetic resonance imaging (MRI). In both CTA and MRI results, the predominant local soft tissue thickening of the posterior pharyngeal wall was a frequently observed finding. Laryngomalacia emerged as the most prevalent comorbid laryngeal abnormality. Notably, among the ten children treated with propranolol, not even one demonstrated a significant therapeutic response.
Conclusion:
The postcricoid cushion, a normal anatomical entity, warrants heightened attention from pediatricians. In most infants, laryngeal stridor or abnormal phonic emissions should elicit concerted vigilance among parents and clinicians. Given that laryngeal imaging modalities typically fail to characterize lesion, laryngoscopy remains paramount for establishing a definitive diagnosis, whereas specific interventions are generally unnecessary. Notably, the inefficacy of empirical β-blocker therapy (e.g., propranolol) underscores the imperative for systematic re-evaluation of diagnostic approaches to mitigate misdiagnosis risks.
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