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Safety and Efficacy of Infant Transoral Flexible Laryngoscopy in the Office Setting

Objectives: The technique of transoral infant laryngoscopy was described a decade ago, but has not gained wide acceptance. We present a 10-year experience with the method as an alternative to transnasal examination in newborns and edentulous infants, focusing on practicality, safety, and quality of examination. Methods: We queried a prospectively accrued database of 22,000 office examinations to identify all transoral flexible laryngoscopy examinations performed from 2001 to 2011 by the senior author. Records were reviewed for patient age, indication for laryngoscopy, diagnoses, and adverse events. Results: One hundred forty infants, aged 2 days to 10 months, were evaluated. Fifty-seven patients were female and 83 were male. Stridor was the most common indication for laryngoscopy (90.7%) and 89 (63.6%) patients were diagnosed with laryngomalacia. The larynx was well seen in 99.3% of examinations. There were no episodes of airway obstruction or bleeding. Two children experienced emesis (1.4%). Conclusions: Transoral flexible laryngoscopy is a safe method for examining the infant larynx. It permits rapid, comfortable examination using a conventional-sized office fiberscope in most infants prior to dental eruption. It avoids the need for topical anesthesia, vasoconstrictors, sedation, or general anesthesia for most children. Office examination is not advised for infants with severe upper airway obstruction.