After endotracheal intubation, a child develops stridor; what is the next best diagnostic step?

• A. Neck radiograph
• B. Laryngoscopy
• C. Bronchoscopy
• D. Endoscopic airway evaluation

Answer: (D)

Post-extubation stridor in a child signals possible airway edema or obstruction, and the most informative next step is to directly visualize the airway. Endoscopic airway evaluation provides a real-time, direct view from the larynx down through the subglottic region and into the proximal trachea, helping to identify edema, stenosis, unusual tissue, or dynamic airway collapse and to gauge severity. It can be performed with flexible or rigid scopes by an airway specialist and often guides immediate management, such as whether conservative therapy is sufficient or if further airway intervention is needed. Neck radiographs lack sensitivity for soft-tissue edema and dynamic airway changes, laryngoscopy alone may miss subglottic or tracheal pathology, and bronchoscopy, while valuable for distal airways, is more invasive and not the initial diagnostic step when a comprehensive airway assessment is needed.