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December 1996

Diagnosis of Laryngomalacia Is Not Enough!

Author Affiliations

Pittsburgh, Pa
Boston, Mass
Cincinnati, Ohio

Arch Otolaryngol Head Neck Surg. 1996;122(12):1417. doi:10.1001/archotol.1996.01890240123028

We are deeply disturbed by the recently published article by Mancuso et all in which they suggest omitting rigid endoscopy when a diagnosis of laryngomalacia is made in infants by flexible fiberoptic laryngoscopy, since their study found that "clinically significant synchronousairway lesions requiringsurgical intervention are uncommon." We have previously reported our experience with the frequency of finding 1 or more other abnormalities of the airway by rigid laryngoscopy and bronchoscopy in the presence of laryngomalacia, and we, like the pioneers in bronchoesophagology, such as Chevalier Jackson and Paul D. Holinger, are on record as recommending a complete evaluation ofthe tracheobronchial tree in all symptomatic infants.2-4 The conclusions and recommendation by Mancuso and colleagues1 are not justified by the design and method they chose to address the question. Since rigid endoscopy is the current "gold standard," any one or combination of new diagnostic tests or procedures proposed must be evaluated against that standard. The accepted scientific

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