Background and Aim: One of the most frequent complaints that bring a child to the hospital is noisy breathing which causes a lot of anxiety to the parents. Pediatricians are the first responders to this complaint, and managing such patients can challenge the skills of even of the most astute clinicians. We conducted this study intending to provide a simple algorithm with endoscopy as a primary tool to diagnose patients presenting with stridor of more than one-month duration Methods: Thirty-five patients were consecutively enrolled and given a number (1-35) in the same order. After due consent and proper preparation, endoscopic video evaluation was performed by the experts under sedation who were not part of the study. Results: All thirty-five patients were investigated and managed according to the standard protocol. The most common chief complaint was noisy breathing of more than one-month duration (n=24). We also found a correlation between the time of commencement of stridor and the likely etiology behind the stridor. The most common associate diagnosis was pneumonia with stridor. (n=6). (n=33) (94.28%) patients had abnormal findings at endoscopy out of which (n=17)(48.57%) patients required surgical management, whereas (n=18)(51.42%) patients were managed conservatively. Conclusion: we conclude that endoscopic evaluation should be performed in all patients presenting with chronic stridor to assess the airway and guide further investigations and management. We offer a simple diagnostic algorithm for approaching a child with chronic stridor that will save valuable time dealing with such patients.

A 12-year-old girl presented with chronic suppurative lung disease secondary to an old forgotten, foreign body (plastic whistle) in the right lower lobe bronchus, confirmed by Contrast enhanced computer tomography (CECT) chest. Rigid bronchoscopic removal was attempted twice but the foreign body could not be removed. Under general anesthesia, a flexible bronchoscope was inserted through the rigid bronchoscope and the foreign body was grasped and removed using rat-toothed forceps inserted through the suction channel of the flexible scope. Although there are a few reports of sequential use of flexible and rigid bronchoscopies, this report highlights the feasibility and utility of flexible through rigid bronchoscopy technique for foreign body removal in the distal airways.