Abstract
In most cases, laryngomalacia presents as a mild disease, and the symptoms resolve after wait-and-see policy. Up to 20 % of patients present with severe laryngomalacia and may require surgery (i.e. supraglottoplasty); however, the indication for surgery is not firmly established yet. The goal of this study is to determine whether supraglottoplasty results in a better outcome than wait-and-see and to investigate how different comorbidities influence outcome. A retrospective study of pediatric cases of in a tertiary referral center was performed. Photo and video documentation was available and revised in all cases. Electronic and paper charts were reviewed for the following variables: gender, sex, gestational age, birth weight, symptoms, comorbidity, date of endoscopy, severity and type of laryngomalacia, treatment modality and technique and follow-up data and a total 89 patients were included. Supraglottoplasty was found to lead to significantly faster complete improvement of laryngomalacia than wait-and-see policy (5 weeks vs. 29, p = 0.026). Synchronous airway lesions (SALs) were present in 40.4 % of patients and were associated with prolonged symptoms of laryngomalacia (38.5 weeks vs. 14.5, p = 0.043). Supraglottoplasty is safe and effective in treatment of severe laryngomalacia. SALs and comorbidities are frequently found in patients with laryngomalacia and are responsible for longer onset of complaints.Electronic supplementary materialThe online version of this article (doi:10.1007/s00405-016-3943-3) contains supplementary material, which is available to authorized users.
Highlights
Congenital laryngomalacia is the most common etiology causing stridor in infants with a reported incidence of 35–75 % of patients [1]
In most cases, laryngomalacia presents as a mild disease, and the symptoms resolve after wait-and-see policy
The most commonly found comorbidity was synchronous airway lesions (SALs) with 36 cases (40 %), showing 54 airway lesions: several patients had more than one synchronous airway lesion
Summary
Congenital laryngomalacia is the most common etiology causing stridor in infants with a reported incidence of 35–75 % of patients [1]. In most cases laryngomalacia presents with inspiratory, sometimes with in- and expiratory, stridor. Symptoms are not present at birth, start within the first 4 months of life and peak at an age of 4–8 months [2]. An estimated 40 % of infants presenting with laryngomalacia have mild and 40 % have moderate symptoms and can be treated conservatively, spontaneously resolving at the age of 12–24 months [1]. Up to 20 % of laryngomalacia patients present with severe laryngomalacia. Severe laryngomalacia is not likely to cure spontaneously, and is more likely to require supraglottoplasty [4]
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