The role of laryngeal ultrasound in the assessment of pediatric dysphonia and stridor.

Objectives: Dysphonia and stridor are not infrequent in the pediatric population. Awake nasolaryngoscopy (ANL) is the primary diagnostic procedure used to evaluate a child with stridor and/or dysphonia. The major limitation of this technique is poor cooperation in children, resulting in inadequate visualization of the larynx. Ultrasound is a widely used noninvasive imaging modality that has yet to be applied to the laryngeal examination. Our goal was to investigate the feasibility and diagnostic potential of laryngeal ultrasound (LUS) in cases of pediatric stridor and/or dysphonia.

Methods: Prospective blinded cohort study of infants and children 0-16 years of age referred for ANL due to voice disorders and/or stridor. Prior knowledge of the etiology was considered an exclusion criterion.

Results: LUS concurred with the ANL in the diagnosis of abnormal vs normal larynx in 28/32 children that were recruited. LUS had a sensitivity and specificity of 87% (95% CI: 69%-96%) and 100% (95% CI: 16%-100%) respectively, for diagnosing overall laryngeal disorders in comparison to ANL. LUS also had an area under the receiver operating characteristic (ROC) curve (AUC) of 0.93, (P = 0.04, 95% CI: 0.84-1).

Conclusion: LUS may be applied as an adjuvant diagnostic tool for ruling in laryngeal pathologies in children including dysphonia and stridor. As further experience is acquired the value of LUS in diagnosis will be better understood.