Quantitative assessment of the upper airway in infants and children with subglottic stenosis

Carlton Zdanski, Stephanie Davis, Yi Hong, Di Miao, Cory Quammen, Sorin Mitran, Brad Davis, Marc Niethammer, Julia Kimbell, Elizabeth Pitkin, Jason Fine, Lynn Fordham, Bradley Vaughn, Richard Superfine

Research output: Contribution to journalArticle

7 Citations (Scopus)

Abstract

Objectives/Hypothesis 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. Study Design Retrospective chart and imaging review in a tertiary care hospital. Methods 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. Results 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. Conclusions 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.

Original languageEnglish (US)
Pages (from-to)1225-1231
Number of pages7
JournalLaryngoscope
Volume126
Issue number5
DOIs
StatePublished - May 1 2016

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Hydrodynamics
Pathologic Constriction
Polysomnography
Atlases
Diagnostic Imaging
Tertiary Healthcare
Arousal
Tertiary Care Centers
Area Under Curve
Therapeutics
Retrospective Studies
Tomography
Pediatrics
Weights and Measures

Keywords

  • airway and voice modeling
  • airway stenosis
  • Pediatric airway
  • subglottic stenosis

ASJC Scopus subject areas

  • Otorhinolaryngology

Cite this

Zdanski, C., Davis, S., Hong, Y., Miao, D., Quammen, C., Mitran, S., ... Superfine, R. (2016). Quantitative assessment of the upper airway in infants and children with subglottic stenosis. Laryngoscope, 126(5), 1225-1231. https://doi.org/10.1002/lary.25482

Quantitative assessment of the upper airway in infants and children with subglottic stenosis. / Zdanski, Carlton; Davis, Stephanie; Hong, Yi; Miao, Di; Quammen, Cory; Mitran, Sorin; Davis, Brad; Niethammer, Marc; Kimbell, Julia; Pitkin, Elizabeth; Fine, Jason; Fordham, Lynn; Vaughn, Bradley; Superfine, Richard.

In: Laryngoscope, Vol. 126, No. 5, 01.05.2016, p. 1225-1231.

Research output: Contribution to journalArticle

Zdanski, C, Davis, S, Hong, Y, Miao, D, Quammen, C, Mitran, S, Davis, B, Niethammer, M, Kimbell, J, Pitkin, E, Fine, J, Fordham, L, Vaughn, B & Superfine, R 2016, 'Quantitative assessment of the upper airway in infants and children with subglottic stenosis', Laryngoscope, vol. 126, no. 5, pp. 1225-1231. https://doi.org/10.1002/lary.25482
Zdanski, Carlton ; Davis, Stephanie ; Hong, Yi ; Miao, Di ; Quammen, Cory ; Mitran, Sorin ; Davis, Brad ; Niethammer, Marc ; Kimbell, Julia ; Pitkin, Elizabeth ; Fine, Jason ; Fordham, Lynn ; Vaughn, Bradley ; Superfine, Richard. / Quantitative assessment of the upper airway in infants and children with subglottic stenosis. In: Laryngoscope. 2016 ; Vol. 126, No. 5. pp. 1225-1231.
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abstract = "Objectives/Hypothesis 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. Study Design Retrospective chart and imaging review in a tertiary care hospital. Methods 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. Results 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. Conclusions 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.",
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