Utility of bronchoscopy for recurrent croup.

OBJECTIVES: We performed a retrospective review to determine the utility of bronchoscopy in patients with recurrent croup (RC).

METHODS: Bronchoscopy was performed on 30 patients with a diagnosis of RC (age, 14 months to 13.9 years) over a 2-year period.

RESULTS: One third of the patients (33.3%) were found to have airway disorders, including subglottic stenosis (7), subglottic edema (2), and a subglottic cyst (1). Patients with RC who were less than 3 years of age were more likely to have an airway abnormality found on endoscopy (9 of 14 or 64.2%) than were those older than 3 years (1 of 16 or 6.2%; chi2 p < 0.001). There was no statistically significant difference in abnormal findings 1) in patients with RC who had a history of prematurity or prior intubations (chi2, p = 0.17 and p = 0.052, respectively); 2) between infectious and spasmodic croup (chi2, p = 0.794); or 3) by number of croup episodes (chi2, p = 0.300). Two patients required surgical intervention (laryngotracheal reconstruction and marsupialization of a subglottic cyst).

CONCLUSIONS: Of 30 patients who underwent bronchoscopy for RC, 33% had airway disorders--mostly children less than 3 years old. We suggest a higher index of suspicion for finding airway disorders in children less than 3 years old with RC and having a lower threshold for performing diagnostic bronchoscopy in this population.