Diagnosis of recurrent intermittent airway obstruction ("recurrent croup")in children

Children with a history of recurrent intermittent airway obstruction can pr esent with a constellation of signs and symptoms labeled by their primary c are physician as "recurrent croup." Recurrent croup, however, is not a diag nosis and should alert the clinician to the potential for intrinsic or extr insic laryngotracheal pathology. This study was undertaken to evaluate refe rral patterns, diagnostic algorithms. and diagnoses for children with a his tory of recurrent intermittent airway obstruction initially characterized a s "recurrent croup." We performed a retrospective analysis of office and op erative records of children with a history of recurrent intermittent airway obstruction characterized as "recurrent croup." The setting was a universi ty-based pediatric otolaryngology practice with both urban and suburban ref erral patterns. The medical records of 53 children (median age, 2 years) wi th a history of mild to severe recurrent intermittent airway obstruction ch aracterized as "recurrent croup" were evaluated with respect to referral so urce, duration of signs and symptoms, diagnostic algorithm, and findings. W e conclude that recurrent intermittent airway obstruction in children is an underappreciated clinical scenario. Upper aerodigestive tract endoscopy is a key component in a diagnostic evaluation to ascertain the cause. The dec ision for an endoscopic evaluation is best determined after analysis of the patient's age, past medical history, clinical severity, and suspected diag nosis. By virtue of his or her knowledge of aerodigestive tract anatomy and endoscopy skills, the otolaryngologist can take a proactive role in arrivi ng at an accurate diagnosis in these children.