{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,1]],"date-time":"2026-08-01T12:06:09Z","timestamp":1785585969061,"version":"3.56.0"},"reference-count":29,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2020,10,14]],"date-time":"2020-10-14T00:00:00Z","timestamp":1602633600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["R01\u2010HL146689"],"award-info":[{"award-number":["R01\u2010HL146689"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["T32\u2010HL007752"],"award-info":[{"award-number":["T32\u2010HL007752"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["The Laryngoscope"],"published-print":{"date-parts":[[2021,4]]},"abstract":"<jats:sec><jats:title>Objectives<\/jats:title><jats:p>Subglottic stenosis (SGS) is the most common type of laryngeal stenosis in neonates. SGS severity is currently graded based on percent area of obstruction (%AO) via the Myer\u2010Cotton grading scale. However, patients with similar %AO can have widely different clinical courses. Computational fluid dynamics (CFD) based on patient\u2010specific imaging can quantify the relationship between airway geometry and flow dynamics. We investigated the effect of %AO and axial position of SGS on work of breathing (WOB) in neonates using magnetic resonance imaging.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>High\u2010resolution ultrashort echo\u2010time MRI of the chest and airway was obtained in three neonatal patients with no suspected airway abnormalities; images were segmented to construct three\u2010dimensional (3D) models of the neonatal airways. These models were then modified with virtual SGSs of varying %AO and axial positioning.<\/jats:p><jats:p>CFD simulations of peak inspiratory flow were used to calculate patient\u2010specific WOB in nonstenotic and artificially stenosed airway models.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>CFD simulations demonstrated a relationship between stenosis geometry and WOB increase. WOB rapidly increased with %AO greater than about 70%. Changes in axial position could also increase WOB by approximately the same amount as a 10% increase in %AO. Increased WOB was particularly pronounced when the SGS lumen was misaligned with the glottic jet.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>The results indicate a strong, predictable relationship between WOB and axial position of the stenotic lumen relative to the glottis, which has not been previously reported. These findings may lead to precision diagnosis and treatment prediction tools in individual patients.<\/jats:p><\/jats:sec><jats:sec><jats:title>Level of Evidence<\/jats:title><jats:p>4 <jats:italic>Laryngoscope<\/jats:italic>, 131:E1220\u2013E1226, 2021<\/jats:p><\/jats:sec>","DOI":"10.1002\/lary.29169","type":"journal-article","created":{"date-parts":[[2020,10,14]],"date-time":"2020-10-14T13:22:17Z","timestamp":1602681737000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":18,"title":["Subglottic Stenosis Position Affects Work of Breathing"],"prefix":"10.1002","volume":"131","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9808-0675","authenticated-orcid":false,"given":"Max M.","family":"Yang","sequence":"first","affiliation":[{"name":"University of Cincinnati College of Medicine  Cincinnati Ohio U.S.A."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nara S.","family":"Higano","sequence":"additional","affiliation":[{"name":"Center for Pulmonary Imaging Research, Cincinnati Children's Hospital Medical Center  Cincinnati Ohio U.S.A."},{"name":"Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center  Cincinnati Ohio U.S.A."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chamindu C.","family":"Gunatilaka","sequence":"additional","affiliation":[{"name":"Center for Pulmonary Imaging Research, Cincinnati Children's Hospital Medical Center  Cincinnati Ohio U.S.A."},{"name":"Department of Physics University of Cincinnati  Cincinnati Ohio U.S.A."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9222-898X","authenticated-orcid":false,"given":"Erik B.","family":"Hysinger","sequence":"additional","affiliation":[{"name":"Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center  Cincinnati Ohio U.S.A."},{"name":"Department of Pediatrics University of Cincinnati  Cincinnati Ohio U.S.A."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Raouf S.","family":"Amin","sequence":"additional","affiliation":[{"name":"Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center  Cincinnati Ohio U.S.A."},{"name":"Department of Pediatrics University of Cincinnati  Cincinnati Ohio U.S.A."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jason C.","family":"Woods","sequence":"additional","affiliation":[{"name":"Center for Pulmonary Imaging Research, Cincinnati Children's Hospital Medical Center  Cincinnati Ohio U.S.A."},{"name":"Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center  Cincinnati Ohio U.S.A."},{"name":"Department of Physics University of Cincinnati  Cincinnati Ohio U.S.A."},{"name":"Department of Pediatrics University of Cincinnati  Cincinnati Ohio U.S.A."},{"name":"Department of Radiology, Cincinnati Children's Hospital Medical Center  Cincinnati Ohio 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