Diagnosis Of Laryngomalacia Research Articles

Polisomnographic findings on children with laryngopathies

SummaryPolysomnography is the goldstandard exam for child OSAS. When possible, polysomnography clearly distinguishes between those with isolated primary snoring and patients with sleep apnea (obstructive, central and mixed). The most common cause of OSAS in childhood is adenotonsillar hypertrophy. Laryngomalacia is the most common cause of stridor in childhood, though its physiopathology remains unknown. Among the most prominent theories are immaturity of the cartilaginous framework of the larynx and/or neuromuscular immaturity. Objective: Our proposal was to describe polysomnographic findings in children with laryngomalacia or other isolated laryngeal alterations, that is, without other alterations in the upper airways. Methods: The sample included 29 children with exclusively laryngeal alterations. All of them underwent an otorhinolaryngological exam, nasofibrolaryngoscopy and polysomnography. Information was recorded concerning age, nasofibrolaryngoscopy and polysomnography. For analysis, the children were divided into two groups: those with laryngomalacia and those with other laryngeal diseases. Results: Among the 18 children with a diagnosis of laryngomalacia, 18 had central breathing events, knowing that the majority had showed dessaturation of oxihemoglobin and bradicardia. In this same group, 3 children had obstrutives events. On the other hand, 11 children with other laryngeal alterations showed no predominance of one type or another of apnea. Of these, 4 had central type breathing events and 2 obstructive type. Conclusion: The majority of patients with laryngomalacia showed a central type apnea. Patients with various laryngeal diseases did not present a predominant type of apnea.

J2/343 – Diagnosis of laryngomalacia by fiberoptic endoscopy

J2/343 – Diagnosis of laryngomalacia by fiberoptic endoscopy

SUPRAGLOTTIC CLOSURE DURING INHALATION AS A CAUSE OF EPISODIC DYSPNEA ON EXERTION

INTRODUCTION: A forty-four year old woman was referred for refractory asthma characterized by fifteen years of variable dyspnea, worse on exertion and associated with audible wheezing. She had responded poorly to inhaled and oral glucocorticoids. Flexible rhinolaryngoscopy showed collapse of the arytenoids during sniff maneuver resulting in supraglottic airway obstruction. A diagnosis of laryngomalacia was made. The otorhinolaryngologists recommended resection of redundant aryepiglottic folds and cuneiform cartilages but the patient refused the procedure.

Gastroesophageal reflux association with laryngomalacia: a prospective study

Objective: To identify the incidence and clinical role of gastroesophageal reflux (GER) in patients with laryngomalacia. Design: Prospective evaluation of consecutive infants with a new diagnosis of laryngomalacia with an initial questionnaire, a barium esophagram or 24 h pH probe and record of their subsequent clinical course. Setting: A large, tertiary pediatric referral center and its associated outpatient clinic. Patients: New diagnosis of laryngomalacia in 33 consecutive infants were evaluated by questionnaire and 27 of these were evaluated for GER. Results: GER was observed in 64% of patients and was significantly associated with severe symptoms and complicated clinical course (P=0.0163). The presence of smokers in the infant's household negatively impacted his or her clinical course and symptomatology (P=0.013) as did the presence of other major, concurrent medical problems (P=0.065). Conclusions: In patients with laryngomalacia, GER was significantly associated with severe symptoms (a complicated clinical course), as was smoking in an infant's household and other significant medical problems.