Flexible nasal laryngoscopy is the gold standard examination for laryngeal assessment, but can be uncomfortable, poorly tolerated or even refused by children. Ultrasonography is non-invasive and well-tolerated and could provide an alternative. Data in children, however, are scarce.

To assess the feasibility of in-office ultrasonography in children for the identification of laryngeal structures using reference imaging planes, and to determine factors influencing examination quality.

A single-center non-interventional prospective pilot feasibility study of a diagnostic tool was conducted in children aged 0 to 15 years. Ultrasonographic images were evaluated by the performing operator and by a second blinded observer using recorded sequences. Qualitative data and inter-rater agreement were expressed as percentages. Association was assessed by logistic regression, with the significance threshold set at 1%.

One hundred and forty children were included. The 5 ultrasound planes – axial glottic, subglottic and tracheal, and sagittal median and paramedian – allowed visualization of the thyroid, cricoid and arytenoid cartilage and vocal fold mobility in more than 95% of cases for both assessors. Age and gender effects differed between assessors, while BMI showed no significant effect. Calcification foci, without posterior acoustic shadowing, did not interfere with structural analysis.

We demonstrated the feasibility of pediatric laryngeal ultrasonography using 5 reference planes, enabling visualization of laryngeal structures regardless of calcifications.