Associated airway anomalies and their impact in patients with laryngomalacia: A retrospective review

Abstract

Introduction: Laryngomalacia is the most common cause of stridor in newborn constituting 50%–75% of all airway anomalies. It is graded as mild, moderate, and severe on the basis of presenting features. It has been shown that 12%–64% of laryngomalacia present with other associated airway anomalies. Here, we have tried to find out the incidence of associated anomalies with laryngomalacia and their impact on the patient's management and prognosis. Materials and Methods: We reviewed patients with laryngomalacia visiting laryngology clinic from January 2014 to January 2019. The incidence and type of associated anomalies; their impact on management protocol and hospital stay; and their association with mild, moderate, and severe grades of laryngomalacia were evaluated. Results: A total of 63 patients were included in the study. Most of the patients presented with severe laryngomalacia (34/63 [53.9%]). Out of them, associated anomalies were present in 23/63 (36%) patients, more common in severe laryngomalacia (16/34 [47.05%]). Tracheomalacia was the most common anomaly (9/63 [14.28%]). The management protocol was changed on the basis of the associated anomalies. The six out of nine patients with tracheomalacia underwent tracheostomy and watchful waiting was done for the other three. The bilateral vocal cords palsy patients underwent partial arytenoidectomy, direct laryngoscopic dilatation was done for all cases of subglottic stenosis, the vallecular cyst patient underwent excision of the cyst and for the patient with laryngeal cleft repairing of the cleft was done after freshening the margins of the cleft. Patients with associated anomalies had statistically significant increased duration of hospital stay (11.35 days) as compared to patients without these anomalies (7.5 days). Conclusion: It can be concluded that associated anomalies are present in a significant number of patients with laryngomalacia and can result in the modification of management protocol and increase in the duration of hospital stay.