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Introduction
Flexible laryngoscopy is now an indispensable tool in ENT practice. It has superseded direct and mirror laryngoscopy. This is because it allows the clinician to thoroughly assess the functional anatomy of the larynx in the awake patient, without the need for sedation or anaesthesia.
Whilst this is true in adults, assessment of the paediatric airway still poses a challenge for clinicians. The most common indication for visualisation of the larynx in the neonate is stridor, of which laryngomalacia is the main cause. Per-oral flexible laryngoscopy in the neonate is well documented. This technique has replaced the more traditional method of rigid laryngoscopy under anaesthesia. It has been shown to be a safe and effective procedure; however, in practice it can cause distress to both the patient and parents, which can impede performance of the procedure.
A number of techniques have been reported in the literature that aim to reduce the pain and distress experienced by awake neonates during invasive procedures. We describe a novel pacifier technique for use during flexible laryngoscopy for assessment of the neonatal airway.
Materials and methods
The preparation for this technique is quick and easy. Specifically, a small hole of approximately 5 mm in diameter is cut from the tip of a sterile disposable bottle teat (available in most paediatric wards).
The teat is then gently stroked along the corner of the child's mouth eliciting the 'rooting' reflex, followed by the sucking reflex. This will pacify the patient. Once the flexible laryngoscope is ready, it can slowly be advanced through the hole created at the tip of the teat.
This technique keeps the tip of the laryngoscope central, preventing the neonate from sucking and manipulating the laryngoscope tip with its tongue.
The child usually remains calm, making the experience less distressing for both the patient and their parents if present (Figure 1).
Fig. 1
Photograph taken during flexible laryngoscopy, showing the 'pacifier' in situ.