The aim of this paper is to present our experience in applying videolaryngoscopy in laryngopathy diagnostics in children, and to present several cases where patients have been diagnosed with significant aberrations in larynx images. Laryngoscopic examination in children is difficult and time-consuming.

Kornut and Venet, examining a group of 50 children aged 5 to 14, could evaluate the larynx during the first examination in only 16 cases. Videolaryngoscopy proved helpful by providing much more information, enabling diagnosis and treatment.

The advantages of videolaryngoscopy are generally known. In our practice the following features are most useful:

Receiving the image on a monitor - this enables evaluation of an image by a number of people at the same time and a joint diagnosis.

Playing the image in slow motion - the examination of a child is often made very quickly and deviations are spotted only after playing the tape repeatedly.

The image of the larynx recorded on a cassette can be consulted at other medical centres without the need to move the patient.

An 8-year-old boy, referred for chronic hoarseness, intensifying up to aphonia.

Laryngoscopy showed the centre of the left vocal fold to be swollen, bright red, glossy, and the fold surface uneven. Stroboscopic examination revealed asymmetrical vibration of vocal folds, amplitude reduction, with border shift on left side slightly marked. Diagnosed as haemorrhaging into the vocal fold. After treatment, the effusion was absorbed.

An 11-year-old boy, treated for hyperfunctional disphonia and vocal nodules. Examination revealed a triangular sharp shape, on the right vocal fold lesion, protruding from under the vocal fold, and of the same colour as the fold, projecting into the lumen of the glottis. Preliminary diagnosis: hyperkeratosis, resembling a cutaneous horn. The child was being prepared for surgical removal of the lesion but, before the operation, the lesion grew smaller and soon disappeared.

A 2-year-old girl with hoarseness for 4 months but no symptoms of dyspnoea. During examination, the child had aphonia. A month earlier, the child had undergone directoscopy at another clinic and no pathological changes in the larynx had been observed. Videolaryngoscopy examination revealed a grooved epiglottis, and whitish mulberry-shaped masses in the vestibule of the larynx descending towards the glottis vera. Diagnosis: laryngeal papilloma.

A 14-year-old girl after total strumectomy for medullary carcinoma of the thyroid gland. Aphonia without symptoms of dyspnoea, after surgery.

Videolaryngoscopy examination revealed pale folds, smooth, right vocal fold set medially, inert, left vocal fold in intermediate during respiration position, weak mobility, no occlusion during phonation. Around posterior commisure visible surplus tissue in the shape of irregular peppercorn sized nodules, pinkish in colour, hanging close to the surface of the vocal folds. Posterior commisure with a pointed shape. Preliminary diagnosis - post-intubation complications, suspicion of torn inter-arytenoid muscle and dislocation of corniculate cartilage. Patient requires further observation.

A 10-year-old girl with advanced Von Recklinghausen´s disease, laryngeal stridor heard under strain. Videolaryngoscopy revealed epiglottis regular, vocal folds grey with smooth surface, a visible coccus of peppercorn size in posterior 1/3 of the left vocal fold. Vocal folds set medially, barely mobile during respiration and phonation, during respiration glottis vera about 3 mm. Diagnosis: paresis chordae vocalis bilateralis.

A 16-year-old patient, history revealing acute mycotic inflammation of the larynx and throat, plus paresis of upper larynx nerves during SLE and therapeutic bronchoscopy.

Laryngeal image 2 weeks after bronchoscopy and regression of acute inflammatory symptoms: epiglottis regular, vocal folds grey, irregular thickening of the surface, asymmetry of vocal folds prominent - left fold wider. Position and mobility of arytenoids regular during respiration and phonation.

Vocal folds displayed weak tone, mobile during respiration, occlusion incomplete during phonation, phonation of whole vestibular folds dominates.

Image 2 months later - regression of inflammatory symptoms of the larynx, but coccus appeared in posterior 1/3 of the left vocal fold. Change regressing on its own after a few weeks.

Image 4 months later - vocal folds white, smooth, regular mobility.

Videolaryngoscopy is a very valuable method of examination, with enormous importance in the diagnostics, documentation and treatment of laryngopathy.

The possibility of examining young children and lowering the age limit of children undergoing examination is a great improvement in laryngopathological diagnostics in children in their developmental years.