medical billing transcription supplier information

Study objective: To evaluate the practice of using nasopharyngoscopy without routine fiberoptic bronchoscopy for children presenting to a pediatric pulmonary practice with nonspecific noisy breathing.

Design: Retrospective chart review. Records of patients who underwent nasopharyngoscopy between January 1, 1990, and December 31, 1999, were reviewed. Follow-up was obtained by office records and direct contact with the patient's family and/or primary care physician.

Setting: Academic, tertiary care facility.

Results: Eighty-one children who underwent upper airway endoscopy to evaluate noisy breathing consistent with extrathoracic lesions were identified. One child had two evaluations separated by years for differing complaints, making a total of 82 procedures. Strider was the chief complaint in three fourths of the children. Half of the children with strider were found to have laryngomalacia. Long-term follow-up was available for 75 of 81 children, with median follow-up of 6 years (range, 1 to 13 years). No medical problems related to missed airway lesions developed in any infants initially evaluated using nasopharyngoscopy.

Conclusions: Nasopharyngoscopy without lower airway endoscopy can be used safely for the initial evaluation of noisy breathing in infants and children provided excellent follow-up is available.

Infants and children who present to primary care physicians with the nonspecific complaint of noisy breathing often are referred to pediatric pulmonologists or otolaryngologists. Some have argued that the lower airway should be visualized in all children with hoarseness, stridor, and other upper airway sounds due to the possibility of finding a concomitant sublaryngeal lesion. (1-5) Since it is not obvious from the published material that clinically significant lesions would be missed, the practice at our institution has been to use procedures less invasive than full endoscopic visualization of the lower airways for the initial evaluation of children when the history and physical examination are highly suggestive of a sole upper airway problem. We reviewed the outcomes of our patients over a 10-year period to determine if our practice pattern was appropriate.

# posted by Medical Information : 2:56 AM