title: Synchronous airway lesions in children: an analysis of characteristics and comorbidities.
abstract: OBJECTIVE
  To analyze the characteristics and the associated medical co-morbidities in children with synchronous airway lesions (SALs) found during rigid bronchoscopy.
  
  
  METHODS
  Retrospective case series and chart review of patients who were found to have more than one airway lesion after undergoing airway evaluation via rigid endoscopy at a tertiary care pediatric hospital between 2001 and 2011. Patient demographics, presence of associated non-airway pathologies, and the number and types of airway lesions were collected. For analysis, airway lesions were classified based on the anatomical subsites involved (supraglottic, glottic, subglottic, tracheal and bronchial).
  
  
  RESULTS
  Out of 592 rigid bronchoscopies performed, there were 73 cases with SALs (12.3%). Of these, only 20% of patients were term infants without associated congenital anomalies. Over 70% of patients with SALs have combinations of lesions involving the trachea, subglottis and supraglottis. Neurological anomalies and GERD were both independently associated with a three-time increase in the odds of having synchronous involvement of these three anatomical subsites (OR 3.15, 95% CI 1.06-9.41; OR 3.0, 95% CI 1.05-8.50, respectively). Glottic lesions were present in 28.7% of patients. Prematurity and cardiac anomalies were both associated with tendency of doubling the odds of glottic lesions (OR 2.34, 95% CI 0.84-6.52; OR 2.0, 95% CI 0.76-5.60, respectively). Overall, almost 10% of newly diagnosed lesions in context of SALs required an additional intervention.
  
  
  CONCLUSIONS
  The majority of patients with SALs are either born prematurely or have associated congenital anomalies. In SAL patients with associated neurological anomalies or GERD, the lesions are more likely to be localized to the supraglottis, subglottis and trachea whereas prematurity and cardiac anomalies could both be increasing the odds of a glottic lesion. High suspicious index should be kept in mind when rigid bronchoscopy is performed to not miss an associated lesion.
authors: Faculty of Medicine, McGill University, Montreal, QC, Canada.
authors: Dennis
authors: D
authors: Ho-Wo-Cheong
authors: Department of Otolaryngology-Head and Neck Surgery, McGill University, Montreal, QC, Canada.
authors: Tamara
authors: T
authors: Mijovic
authors: Department of Otolaryngology-Head and Neck Surgery, McGill University, Montreal, QC, Canada.
authors: John J
authors: JJ
authors: Manoukian
authors: Department of Otolaryngology-Head and Neck Surgery, Laval University, Quebec City, QC, Canada.
authors: Mathieu
authors: M
authors: Bergeron
authors: Department of Otolaryngology-Head and Neck Surgery, McGill University, Montreal, QC, Canada; Center for Medical Education, McGill University, Montreal, QC, Canada. Electronic address: lily.hp.nguyen@gmail.com.
authors: Lily H P
authors: LH
authors: Nguyen
mesh_terms: D000293:Adolescent; D001999:Bronchoscopy; D002648:Child; D002675:Child, Preschool; D015897:Comorbidity; D000013:Congenital Abnormalities / Q000453:epidemiology; D005260:Female; D005764:Gastroesophageal Reflux / Q000453:epidemiology; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D047928:Premature Birth; D011792:Quebec / Q000453:epidemiology; D012140:Respiratory Tract Diseases / Q000175:diagnosis* / Q000453:epidemiology; D012189:Retrospective Studies
keywords: GERD; Neurological anomalies; Pediatrics; Rigid bronchoscopy; Synchronous airway lesions