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ENT Secrets > Chapter 48 - chronic pediatric airway diseases > Flashcards

Chapter 48 - chronic pediatric airway diseases Flashcards

1
Q

2 most common causes of stridor in infant

A

laryngomalacia

unilateral VC paralysis (usually iatrogenic)

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2
Q

By what age do kids outgrow laryngomalacia?

A

18-24 mo

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3
Q

Most common tumor of infancy. And where are most found?

A

infantile hemangioma, H/N

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4
Q

Which types of HPV must be targeted by vaccines to decrease risk of RRP?

A

6, 11

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5
Q

When is stridor worse with laryngomalacia

A

feeding, supine, or agitated

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6
Q

Percentage of laryngomalacia pts that experience significant UA obstruction. What does this result in?

A

10%
feeding diff/FTT, pectus excavitum, apneic episodes, cyanosis, hypoxia
These pts warrant consideration for surgery

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7
Q

Relationship between GERD and laryngomalacia

A

GERD may contribute to airway edema and further compromise the airway
Acid suppression can improve mild cases of laryngomalacia

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8
Q

Size of term infant subglottic lumen

A

4.5-5.5mm

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9
Q

What does a 4.0 ETT mean?

A

inner diameter 4mm

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10
Q

Formula to choose ETT size…and which age group does this work in

A

inner diameter = 4 + age/4

More accurate for older children

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11
Q

Causes of congenital subglottic stenosis

A 
elliptical cricoid
congenital narrowing (Downs, trapped 1st tracheal ring)
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12
Q

Causes of acquired subglottic stenosis

A 
ETT (duration, size)
neck trauma
laryngeal procedures
caustic ingestion
radiotherapy
tracheal infection
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13
Q

Grading system for SGS

A 
Myer-Cotton
I- 0-50% obstruction
II- 51-70%
III- 71-99%
IV- no detectable lumen
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14
Q

Ways to treat SGS

A

scar lysis with balloon dilation
augmentation (cartilage graft to make airway bigger)
resection (remove affected segment, reanastamose)

If mature, thick lesion, more superior to inferior dimension, may need more than balloon

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15
Q

Embryology of laryngeal cleft

A

TE septum forms caudal to cranial, cleft forms if incomplete development/fusion

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16
Q

Classification system of laryngeal cleft

A

Benjamin-Inglis
1- isolated to supraglottic interarytenoid region, above or at VC
2- extends to upper cricoid, not through lower cricoid
3- through inferior border cricoid, possibly into cervical trachea
4- into thoracic trachea, possibly to carina

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17
Q

Symptoms of laryngeal cleft based on grade

A

I-II: hoarse, stridor, chronic cough, lingering URI, recurrent pneumonia

III-IV: respiratory distress, aspiration, presents at birth

18
Q

Most frequent operation leading to VC paralysis

A

PDA ligation –> left TVC paralysis

Others: TEF repair, esophageal atresia repair, also birth trauma, Chiari (b/l), neoplasm of CNS/neck/mediastinum

19
Q

Name 4 syndromes associated with laryngeal cleft

A

Opitz-Frias
Pallister Hall
VACTERL
CHARGE

20
Q

Opitz-Frias syndrome

A

craniofacial (cleft), GU abnl, midline airway abnl

21
Q

Pallister-Hall syndrome

A

Congenital hypothalamic hamartoblastoma, hypopituitarism, polydactyly, imperforate anus, cardiac abnl, renal malformations

22
Q

VACTERL

A

Vertebral, Anal atresia, Cardiac, TEF, Ear, Renal, Limb

23
Q

Presentation and workup and prognosis of unilateral VC paralysis

A

stridor, weak cry, feeding difficult, possible asp.
Imaging course of RLN from SB to mediastinum
Barium swallow if feeding diff
70% resolve spontaneously within 6 mo age unless iatrogenic (35% recover by 16mo)

24
Q

Treatment for severe sx of unilat VC paralysis

A

VC medialization to improvve speech/swallow

narrows airway at glottis though

25
Q

How many patients with beard hemangiomas have airway ones?

A

50%

26
Q

XR findings suggestive of airway hemangioma

A

asymmetric narrowing subglottis

27
Q

Tx of airway (esp subglottis) hemangioma

A

steroids (stop angiogenesis, DEC inflammation) effective in proliferative phase only
propranolol - mechanism not identified
laser, steroid injection
tracheostomy until spontaneous resolution

28
Q

Diagnosis of tracheomalacia

A

> 50% loss of airway diameter during coughing, with bronchoscopy
Expiratory/biphasic stridor, barky cough, pneumonia prolonged or recurrent

29
Q

Intrinsic vs Extrinsic tracheomalacia

A

Int: cartilage weak/absent, outgrow in first few yrs of life
Tx inhaled steroids for edema
Associated with TEF

Ex: structure outside trachea is compressing the cartilage. Cardiovascular abnl. Do barium esophagram, rigid bronch, CT/MRI

30
Q

Most common benign neoplasm of pediatric larynx

A

RRP

Also occurs in adults, but less aggressive

31
Q

Sx of RRP

A

dysphonia, stridor

32
Q

How HPV 11 RRP differs from 6

A

more airway obstruction, tracheal disease, pulmonary disease, need for trach

33
Q

How many babies born to mothers with active genital condylomata will get RRP?

A

1 in 231

34
Q

Should you do C-section to decrease risk of RRP?

A

ACOG currently does not recommend it

35
Q

Risk factors for RRP development

A

first born child
teenage mother
vaginal delivery (but several cases demonstrate in utero transmission)

36
Q

Tx of RRP

A

cold steel, KTP/CO2 laser

Topical cidofovir

37
Q

Which HPV types does gardasil prevent?

A

6, 11, 31, 33

38
Q

Four phases of swallowing

A

Oral prep - bolus form
Oral propulsive - transport to pharynx
Pharyngeal - pharynx to esophagus, nasopharynx closes, breathing stops, VC adduct, larynx rises, BOT/pharyng mm propel bolus
Esophageal- peristalsis

39
Q

What is aspiration vs penetration

A

Pen: material passing into larynx but not past TVC

Asp: material passing from upper airway to below VC

40
Q

Anatomical abnormalities and neurological conditions associated with aspiration/swallowing difficulty

A

cleft palate, TEF, laryngeal cleft, macroglossia, micrognathia, hypotonia, Downs

41
Q

History items suggestive of aspiration

A

choke with feeds, recurrent pneumonia, wheezing, respiratory distress

42
Q

FEES

A

endoscopic eval of swallowing

nasopharyngeal scope used to watch patient swallow

ENT Secrets (79 decks)

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