title: Quantitative assessment of the upper airway in infants and children with subglottic stenosis.
abstract: Determine whether quantitative geometric measures and a computational fluid dynamic (CFD) model derived from medical imaging of children with subglottic stenosis (SGS) can be effective diagnostic and treatment planning tools.
  
  
  
  Retrospective chart and imaging review in a tertiary care hospital.
  
  
  
  Computed tomography scans (n = 17) of children with SGS were analyzed by geometric and CFD methods. Polysomnograms (n = 15) were also analyzed. Radiographic data were age/weight flow normalized and were compared to an atlas created from radiographically normal airways. Five geometric, seven CFD, and five polysomnography measures were analyzed. Statistical analysis utilized a two-sample t test with Bonferroni correction and area under the curve analysis.
  
  
  
  Two geometric indices (the ratio of the subglottic to midtracheal airway, the percent relative reduction of the subglottic airway) and one CFD measure (the percent relative reduction of the hydraulic diameter of the subglottic airway) were significant for determining which children with SGS received surgical intervention. Optimal cutoffs for these values were determined. Polysomnography, the respiratory effort-related arousals index, was significant only prior to Bonferroni correction for determining which children received surgical intervention.
  
  
  
  Geometric and CFD variables were sensitive at determining which patients with SGS received surgical intervention. Discrete quantitative assessment of the pediatric airway was performed, yielding preliminary data regarding possible objective thresholds for surgical versus nonsurgical treatment of disease. This study is limited by its small, retrospective, single-institution nature. Further studies to validate these findings and possibly optimize treatment threshold recommendations are warranted.
  
  
  
  4 Laryngoscope, 126:1225-1231, 2016.
authors.affiliation: Department of Otolaryngology/Head and Neck Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
authors.forename: Carlton
authors.initials: C
authors.lastname: Zdanski
authors.affiliation: Department of Pediatrics, Section of Pediatric Pulmonology, Allergy and Sleep Medicine, Riley Children's Hospital, Indiana University School of Medicine, Indianapolis, Indiana.
authors.forename: Stephanie
authors.initials: S
authors.lastname: Davis
authors.affiliation: Department of Computer Science, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
authors.forename: Yi
authors.initials: Y
authors.lastname: Hong
authors.affiliation: Department of Statistics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
authors.forename: Di
authors.initials: D
authors.lastname: Miao
authors.affiliation: Kitware, Incorporated, Carrboro, North Carolina.
authors.forename: Cory
authors.initials: C
authors.lastname: Quammen
authors.affiliation: Department of Mathematics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
authors.forename: Sorin
authors.initials: S
authors.lastname: Mitran
authors.affiliation: Kitware, Incorporated, Carrboro, North Carolina.
authors.forename: Brad
authors.initials: B
authors.lastname: Davis
authors.affiliation: Department of Physics and Astronomy, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
authors.forename: Marc
authors.initials: M
authors.lastname: Niethammer
authors.affiliation: Department of Otolaryngology/Head and Neck Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
authors.forename: Julia
authors.initials: J
authors.lastname: Kimbell
authors.affiliation: Department of Pediatrics, Division of Pediatric Pulmonology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Pitkin
authors.affiliation: Department of Computer Science, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
authors.forename: Jason
authors.initials: J
authors.lastname: Fine
authors.affiliation: Department of Radiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
authors.forename: Lynn
authors.initials: L
authors.lastname: Fordham
authors.affiliation: Department of Neurology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
authors.forename: Bradley
authors.initials: B
authors.lastname: Vaughn
authors.affiliation: Department of Physics and Astronomy, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
authors.forename: Richard
authors.initials: R
authors.lastname: Superfine
mesh_terms: D002648:Child; D002675:Child, Preschool; D004568:Electrodiagnosis; D005260:Female; D006801:Humans; D057446:Hydrodynamics; D007223:Infant; D007829:Laryngostenosis / Q000175:diagnosis* / Q000473:pathology / Q000503:physiopathology / Q000601:surgery; D007830:Larynx / Q000473:pathology* / Q000503:physiopathology; D008297:Male; D008954:Models, Biological; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed
keywords: Pediatric airway; airway and voice modeling; airway stenosis; subglottic stenosis