Higher Rates of Adenotonsillectomy or Adenoidectomy for Upper Airway Obstruction in Infants with Severe Laryngomalacia

Abstract

Objectives: Synchronous airway anomalies below the supraglottis are thought to compound the symptoms of laryngomalacia (LM). Upper aerodigestive obstructive lesions may also be present but have not been discussed. This study examines other sources of upper airway obstruction in infants with severe LM requiring supraglottoplasty (SGP). Methods: Data were compiled on infants who received SGP between 2004 and 2011. Those with neurological conditions, syndromes, or major comorbidities were excluded. The incidence, type, and timing of procedures to relieve upper airway obstruction above the larynx were examined in each infant within 4 years after SGP. Results: One hundred fifty-six infants were included. Forty-two (26.9%) had other sources of upper airway obstruction necessitating a surgical procedure beyond SGP. Thirty-two patients required an adenoidectomy alone, either during or within 30 months of SGP. Nine patients required adenotonsillectomy. One patient required tonsillectomy alone. Among the patients who underwent adenoidectomy, tonsillectomy was required later in 6 patients. Age at the time of SGP significantly affected the incidence of additional procedures. Infants receiving SGP at an age greater than 6 months were more likely to require management of adenotonsillar hypertrophy (82.1%) than their younger counterparts (14.8%) ( P < 0.05). Conclusions: Accessory upper airway obstruction due to adenoidal or adenotonsillar hypertrophy, both synchronous and non-synchronous (occurring after) is more common in patients with severe laryngomalacia. Infants older than 6 months receiving SGP are more likely to require additional procedures to relieve upper airway symptoms. Management of accessory sources of upper airway obstruction should be explored in infants with laryngomalacia.