Medical and Surgical Management of Congenital Laryngomalacia: A Retrospective Case‐Control Study

Abstract

Objectives: Compare the growth of infants with moderate to severe laryngomalacia who underwent supraglottoplasty to the growth of those treated with medical therapy alone. Methods: Retrospective case-control chart review of patients treated between 2008 and 2013 in a tertiary care pediatric otolaryngology practice. 51 infants newly diagnosed with moderate to severe congenital laryngomalacia were included. A total of 17 infants underwent supraglottoplasty and 34 matched controls had medical management, which included acid suppression therapy, speech and swallowing therapy, and/or high-calorie formula. The primary outcome measure was weight percentile recorded at the second clinic visit and at the last available follow-up. The secondary outcomes were the need for tracheostomy or gastrostromy, development or persistence of failure to thrive, surgical complications, and new onset developmental delay. The management strategy was considered a success if none of the secondary outcomes occurred. Results: There was no difference in the mean weight percentile between the surgical and nonsurgical groups at the time of last follow-up ( P = .89). Twenty-nine (85%) patients in the medical management group and 12 (71%) in the surgical group were managed successfully. There were no statistically significant differences in the success rate between groups ( P = .27). Conclusions: Medical management and close observation of infants with moderate to severe congenital laryngomalacia may be a viable alternative to supraglottoplasty.