Introduction: Recurrent croup is a frequent indication for referral to paediatric ENT, yet the role of routine microlaryngobronchoscopy (MLB) remains uncertain. We evaluated the prevalence of airway abnormalities, associated risk factors, management and clinical outcomes in children undergoing MLB for recurrent croup.
Methods: A retrospective review was performed of children undergoing MLB for recurrent croup at a tertiary paediatric centre between 2016 and April 2026. Patients undergoing MLB for alternative indications or before six months of age were excluded. Demographics, clinical presentation, endoscopic findings, investigations, treatment and outcomes were analysed.
Results: Of 125 children identified, 121 met the inclusion criteria. Median age at symptom onset was 12.4 months and median age at ENT review was 40 months. Children experienced a median of 3.5 croup episodes annually, with 42% requiring hospital admission. Airway abnormalities were identified in 76/121 (62.8%) patients; however, structural airway abnormalities were present in only 35/121 (28.9%). The commonest structural abnormalities were laryngomalacia (13.2%) and subglottic stenosis (7.4%). Reflux-type endoscopic findings were uncommon (9.9%). No statistically significant association was demonstrated between structural airway abnormalities and bottle feeding, parental smoking or positive allergy testing. Despite investigation and treatment, 52.9% of children continued to experience recurrent croup during follow-up.
Conclusion: Although non-specific endoscopic abnormalities were frequently identified, clinically significant structural airway pathology was found in fewer than one-third of children. Careful patient selection using recognised risk factors may improve referral pathways and reduce unnecessary invasive airway endoscopy while maintaining diagnostic yield.
References
The management of recurrent croup in children
I RANKIN, S M WANG, AWATERS, WA CLEMENT, H KUBBA
Department of Paediatric Otolaryngology, The Royal Hospital for Sick Children, Glasgow, Scotland, UK