Airway findings in children with tracheostomies: When is diagnostic bronchoscopy and laryngoscopy indicated?

Int J Pediatr Otorhinolaryngol. 2019 Feb:117:73-77. doi: 10.1016/j.ijporl.2018.11.021. Epub 2018 Nov 19.


Objectives: To determine the utility of diagnostic laryngoscopy and bronchoscopy in children with tracheostomies and to describe the incidence of airway findings.

Methods: Retrospective cohort study examining children with tracheostomies who underwent direct laryngoscopy and bronchoscopy (DLB) at Duke University Hospital between 2008 and 2016.

Results: A total of 81 patients who underwent 114 bronchoscopies met inclusion criteria. The median time between tracheostomy and first DLB was 13 months (IQR 4.25-14.75). Sixty-six patients were diagnosed with findings on DLB (81.5%). Suprastomal granulation tissue was the most common complication (59.0%), followed by increased tracheal secretions (23%), stomal and peristomal granulation (13.2%), tracheal ulcer (3.3%), and suprastomal collapse (1.6%). The proportion of patients with airway findings who underwent endoscopy >6 months post-tracheostomy was higher than those <6 months post-tracheostomy, although this did not reach statistical significance (90.6% vs. 75.5%, p = 0.087). However, when examining tracheostomy-related findings, the proportion of patients with airway findings who underwent DLB >6 months post-tracheostomy (61%) compared to <6 months post-tracheostomy (36%) was significantly different (p = 0.026). Patients who were symptomatic before bronchoscopy were more likely to have positive findings (91.9% vs. 72.7%, p = 0.027) and patients were more likely to be symptomatic if they had DLB >6 months after tracheostomy versus <6 months after tracheostomy (68.8% vs. 30.6%; p < 0.001).

Conclusion: The high incidence of airway findings, especially tracheostomy-related findings, noted on DLB supports the continued use of airway endoscopies in children post-tracheostomy. Timing of DLB may play a role in determining utility with evaluation and symptomatic patients should be more closely monitored as they demonstrate higher rates of airway findings.

Keywords: Airway lesion; Bronchoscopy; Laryngoscopy; Monitoring; Surveillance; Tracheostomy.

MeSH terms

  • Adolescent
  • Bronchoscopy / methods*
  • Child
  • Child, Preschool
  • Cohort Studies
  • Female
  • Humans
  • Incidence
  • Infant
  • Infant, Newborn
  • Laryngoscopy / methods*
  • Male
  • Postoperative Complications / epidemiology*
  • Postoperative Complications / etiology
  • Retrospective Studies
  • Tracheostomy / adverse effects*