title: Prevalence and characteristics of tracheal cobblestoning in children.
abstract: BACKGROUND
  Tracheal follicular pattern or so-called tracheal cobblestoning is a poorly described entity in the literature and is depicted as a nodular or lumpy appearance of the tracheal wall mucosa suggesting tracheal irritation from factors like gastro-esophageal reflux (GERD) or pulmonary infection. The aim of the present study was to investigate the prevalence and characteristics of tracheal cobblestones in a large pediatric population.
  
  
  METHODS
  A large database of rigid tracheoscopies recorded in children (0-6 years of age) undergoing general anesthesia with planned tracheal intubation for elective surgical procedures was retrospectively analyzed. Tracheoscopy records were reviewed by five pediatric airway experts (authors 3-7). Data were compared using the Mann-Whitney test, chi-square or Fisher exact test as appropriate (P < 0.05).
  
  
  RESULTS
  A total of 971 rigid tracheoscopy records were analyzed. The median age of the patients was 3.3 years (range 0.4-6.0 yrs). Cobblestones were present in 377 out of 971 patients (38.8%) with a male to female prevalence of 254 (40.6%)/123 (35.5%). None of the children under four months of age showed the presence of cobblestones. The prevalence of cobblestones was significantly less in patients under 3 years of age compared to over 3 years (P < 0.01). There was no association between prevalence of cobblestones and GERD, current or recent respiratory infection or concomitant enlarged tonsils.
  
  
  CONCLUSIONS
  The prevalence of tracheal cobblestones in otherwise healthy children is high and is not associated with GERD or respiratory infection. The gender and age related differences are novel interesting findings that require further investigations.
authors.affiliation: Department of Anaesthesia, University Children's Hospital, Zurich, Switzerland.
authors.forename: Mital H
authors.initials: MH
authors.lastname: Dave
authors.affiliation: Department of Anaesthesia, University Children's Hospital, Zurich, Switzerland.
authors.forename: Andreas
authors.initials: A
authors.lastname: Gerber
authors.affiliation: Department of Paediatric Otolaryngology, Great Ormond Street Hospital for Children, London, United Kingdom.
authors.forename: Martin
authors.initials: M
authors.lastname: Bailey
authors.affiliation: Department of Otorhinolaryngology, University Children's Hospital, Zurich, Switzerland.
authors.forename: Claudine
authors.initials: C
authors.lastname: Gysin
authors.affiliation: Department of Otorhinolaryngology, Sophia Children's Hospital, Erasmus University Medical Centre, Rotterdam, The Netherlands.
authors.forename: Hans
authors.initials: H
authors.lastname: Hoeve
authors.affiliation: Department of Paediatric Pulmonology and Intensive Care Medicine, UKBB, Basel, Switzerland.
authors.forename: Juerg
authors.initials: J
authors.lastname: Hammer
authors.affiliation: Department of Paediatric Pulmonology and Intensive Care Medicine, Dr. von Hauner Children's Hospital, University of Munich, Germany.
authors.forename: Thomas
authors.initials: T
authors.lastname: Nicolai
authors.affiliation: Department of Anaesthesia, University Children's Hospital, Zurich, Switzerland.
authors.forename: Markus
authors.initials: M
authors.lastname: Weiss
mesh_terms: D002648:Child; D002675:Child, Preschool; D004724:Endoscopy; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D015995:Prevalence; D012189:Retrospective Studies; D014132:Trachea / Q000473:pathology*
keywords: Bronchoscopy; clinical trials; respiratory and airway muscle