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The airway starts at the anterior nasal vestibule and ends at the lung parenchyma. This includes the nasal cavity, nasopharynx, oral cavity, oropharynx, larynx, hypopharynx, trachea, and bronchi. When evaluating a child with noisy breathing, it is important to assess the airway in a systematic manner. A thorough history is important. This includes assessment of the severity or progression of symptoms, and whether the symptoms are worse with feeding or increased exertion. The severity determines the urgency of complete evaluation. Apparent life-threatening events (ALTE) warrant prompt multidisciplinary evaluation (McMurray, 1997). Inspiratory stridor generally originates from the larynx, while expiratory stridor from the trachea or bronchi. Stridor that is biphasic (both inspiratory and expiratory) typically indicates a fixed obstructive lesion is present. Depending on symptomatology, the addition of endoscopic evaluation of the airway to the basic physical examination can be extremely beneficial. A definitive diagnosis is critical to proper treatment intervention.

Endoscopy in the Evaluation and Management of the Pediatric Airway