Presence of nocturnal snoring is the cornerstone of diagnosis because examination of the child while awake and in vertical position is rarely suggestive . Tonsillar hypertrophy can be documented by pharyngeal examination, while adenoid hypertrophy is best identified by nasal fibroscopy . The latter represents the second cause of childhood sleep apnea syndrome . Dyskinesia, usually called malacia, can affect upper airways either in isolated or associated patterns. Flexible bronchoscopy is the most important diagnostic tool.
Barium swallows is a simple exam, which allows usually the identification of vascular anomalies.
The diagnosis of gastroesophageal reflux should be considered in the presence of pharyngeal inflammatory signs, which are correlated to the intensity of reflux . Une approche clinique multidisciplinaire. Prescott CAJ . Nasal obstruction in infancy. Attal P, Bobin S, Lepajolec C, Harboun-Cohen E .