Evaluation of the effectiveness of airway fluoroscopy in diagnosing patients with laryngomalacia

Objectives/Hypothesis: To re-evaluate the usefulness of airway fluoroscopy (AF) in diagnosing laryngomalacia and to determine the effectiveness of AF in diagnosing laryngomalacia depending on the specific lesion. Study Design: Retrospective chart review. Methods: Patients from 0 to 12 months of age who presented with stridor were evaluated. Those who underwent AF and flexible fiberoptic laryngoscopy (FFL) and/or direct laryngoscopy (DL) were included in the study. The diagnosis made through AF, FFL, and/ or DL were recorded with those considered definitive made through FFL and/or DL. The sensitivity, specificity, positive predictive value, and negative predictive value of AF compared to FFL and DL were calculated. The sensitivity, specificity, positive predictive value, and negative predictive value of AF with regard to specific sites of laryngeal collapse were calculated. Results: AF showed an inconsistent sensitivity, specificity, and positive and negative predictive value compared to FFL and DL with regard to specific lesions. AF had an overall sensitivity of 35%, specificity of 67%, positive predictive value of 78%, and negative predictive value of 23% when compared to FFL in diagnosing laryngomalacia. When compared to DL, AF had an overall sensitivity of 44%, specificity of 60%, positive predictive value of 67%, and negative predictive value of 38% when diagnosing laryngomalacia. Conclusions: AF is a commonly used modality in the diagnostic workup of a patient with stridor. The effectiveness of AF is limited when compared to endoscopy when used for the evaluation of laryngomalacia.