Type Of Laryngomalacia Research Articles

Characteristics of Patients with Laryngomalacia: A Tertiary Referral Center Experience of 106 Cases.

Laryngomalacia (LM) is the most common airway congenital anomaly and the main cause of stridor in infants. Some patients with severe airway symptoms or with feeding difficulties require surgical intervention. Synchronous airway lesions (SALs) may influence the severity and course of the disease. This study aimed to determine the prevalence of various types of LM and SALs and their influence on surgical intervention decisions and feeding difficulties. Moreover, the study focused on the interrelations between SALs and the type of LM or the presence of feeding difficulties. A retrospective analysis of 106 pediatric patients revealed a significant relationship between type 2 LM and the necessity of surgical treatment. We also found a significant effect of LM type 2 on feeding difficulty. Type 1 LM is significantly more characteristic in premature children. Among different comorbidities, SALs are suspected of modification of the course and severity of LM. This study did not find a significant effect of SALs on the incidence of supraglottoplasty or feeding difficulty.

Coblation supraglottoplasty: a ten-year experience in a tertiary referral hospital.

The present study aims to review the outcomes of coblation supraglottoplasty performed for children with different types of laryngomalacia, and we discuss the factors affecting these outcomes. We retrospectively reviewed the medical records of laryngomalacia patients admitted to the Otorhinolaryngology Department, Mansoura University, from 2010 to 2020. We examined the patient's demography, symptoms, comorbidities, type of laryngomalacia, oxygen saturation, and final outcomes. Our study included 235 patients; 122 patients responded to medical therapy, while 113 underwent surgical management. There is a significant relation between the types and therapy they underwent (p ≤ 0.001). Larger percentage within type I underwent medical therapy. There is a statistically significant difference between the studied groups regarding age at surgery. On pairwise comparison, patients with type II had the lowest age significantly at the surgery when compared with each other individual group (p ≤ 0.001). On multivariate regression analysis, the presence of comorbid congenital heart disease, neurological comorbidities significantly increased the risk of failure of surgical intervention by 17.32 and 5.803 folds, respectively. Coblation supraglottoplasty is effective and safe to treat severe laryngomalacia. Different morphological types of laryngomalacia require slight surgical variations of coblation supraglottoplasty. The presence of comorbid congenital heart disease, neurological comorbidities significantly increased the risk of failure of surgical intervention.

Prevalence of Laryngomalacia among Young Children Presenting with Stridor in a Tertiary Care Hospital.

Laryngomalacia is one of the most common causes of stridor in young children. It can be a serious concern to both parents and caregivers. The main objective of this study is to find the prevalence of laryngomalacia among young children presenting with stridor in a tertiary care hospital in central Nepal. A descriptive cross-sectional study was carried out form 1st December 2017 to 1st May 2020 in children less than two years of age in a tertiary care hospital. Ethical approval was taken from the Institutional Review Committee of the hospital (reference number: 2020/23). Convenient sampling was done. Detailed demography, clinical examination, and video laryngoscopy findings were evaluated to find the prevalence of laryngomalacia among all children with stridor. Data were analyzed by using Statistical Package for the Social Sciences version 20. Point estimate at 95% confidence interval was calculated along with frequency and proportion for binary data. Out of 430 participants who presented with stridor, the laryngomalacia was found in 234 (66%) (58.7-74.07) cases at a 95% confidence interval. The male: female ratio was 1.7:1. Most children, 192 (67.6%), presented with a milder form of laryngomalacia. The most common type was a mixed type of laryngomalacia in 159 (56%). Sleep-disordered breathing was seen in 113 (39.79%) of children diagnosed with laryngomalacia. Our study concluded that laryngomalacia was the most common cause of stridor in children less than two years of age. However, in most cases, the problem is not serious and a regular follow-up with weight monitoring is warranted.

Office-Based Lower Airway Endoscopy: Feasibility and Safety.

The primary aim of this study was to identify the ease and safety of office-based lower airway endoscopy (OLAE) in patients with and without comorbidities. In addition, we identified the most common indications for OLAE and the associated diagnosis. A retrospective review on 567 patients and 706 in-office flexible fiberoptic procedures was performed. Using a previously established grading system, the ease of visualization of the subglottis, trachea, and carina was assessed, in addition to the overall ease of the exam. Four hundred and eighty-eight videos were available for review. Of those, 105 videos included an OLAE, accounting for 21.5% of all procedures. Laryngomalacia was the most common diagnosis in 35 of 105 (36%) OLAE. For all laryngomalacia cases, the overall ease was found to be on average 2.15 (standard error 0.12). Fisher exact testing showed a statistical significance in the ability to visualize the trachea between the types of Laryngomalacia (LM) (P = .035). Fisher exact testing was performed comparing LM types I, II, or III, and combined types of LM; no statistical difference was found between groups. In 4.76% of OLAE procedures, a subglottic pathology was diagnosed. Comorbidities were found in OLAE 26 of 105 patients. There were no complications identified. We found OLAE more challenging than previously reported. OLAE of combined types of laryngomalacia was subjectively more difficult, but this difference did not reach statistical significance. OLAE continues to be a safe alternative to operative laryngoscopy in pediatric patients and appears safe in those with comorbidities when precautions are taken. 4. Laryngoscope, 131:E649-E652, 2021.

Validity of laryngomalacia classification systems: A multi-institutional agreement study.

To determine the agreement of paediatric otolaryngologists on classifying laryngomalacia (LM). Intra- and interobserver agreement study of two classification systems. Three tertiary referral paediatric centres. Three paediatric otolaryngologists, who were blinded to any clinical details, interpreted the videos of children diagnosed with LM using the Holinger and Olney classifications independently. They rated the videos twice with a washout period of at least 2weeks. Inter- and intra-observer agreement measured by overall Fleiss kappa and unweighted Cohen's kappa coefficients. The secondary outcome measures were inter- and intra-observer agreement on the individual anatomical subunits of the supraglottis affected by LM, characterised by the subcategories of the classifications. Video records of infants and children <18years who had an endoscopic diagnosis of LM from 2012 to 2017 were retrospectively chosen for inclusion (n=73). The overall Fleiss kappa coefficient was 0.25 (95% CI 0.18-0.32) amongst the raters using the Holinger classification and 0.31 (95% CI 0.21-0.42) for the Olney classification. Intra-observer agreement using the Holinger classification was 0.30 (95% CI 0.18-0.42), 0.62 (95% CI 0.23-0.85) and 0.84 (95% CI 0.75-0.94], whilst the Olney classification yielded values of 0.41 (95% CI 0.26-0.56), 0.51 (95% CI 0.29-0.63) and 0.63 (95% CI 0.48-0.78). The agreement on types of LM between expert observers is modest using the Holinger and Olney classifications. This has significant implications for accurately diagnosing LM and exposes potential obstacles against credible pooling of data and extrapolation of information.

DOZ047.44: Coblation supraglottoplasty for symptomatic laryngomalacia

Abstract Background Laryngomalacia is the commonest cause of congenital laryngeal stridor and supraglottoplasty is the mainstay of surgical treatment for symptomatic laryngomalacia. A variety of techniques used for ablating redundant tissue in the supraglottis. Novel supraglottoplasty surgical technique is needed to achieve better safety and efficacy. The purpose of this study is to evaluate the outcome and effectiveness of supraglottoplasty. Methods A total of 71 patients with laryngomalacia were studied retrospectively. Of 20 patients with symptomatic laryngomalacia underwent supraglottoplasty and 48 patients were treated conservatively. Two patients refused surgical management. Of 80% underwent successive apnea technique, rest under ETGA. The number of patients who underwent supraglottoplasty technique 14 was of coblation, 3 were of cold steel, 1 was of coagulation, 1 was of laser, and 1 was of microdebrider. The patients were kept under observation in intensive care unit (ICU) from 1 to 3 days then in step downward for 3 to 5 days. No child was intubated in the postoperative period. The patient's demographic information, symptoms, comorbidities, type of laryngomalacia, synchronous airway lesions, and final outcomes were examined. Results The common indications for surgery were feeding problems and failure to thrive along with inspiratory stridor. Most common type of laryngomalacia was type 2 (71%). Good weight gain happened for 18 patients, one patient had to be continued on gastrostomy feeding, one patient did not gain weight. Majority of the patients continued to have some amount of noisy breathing and eventually settled in 3 months postoperatively. No perioperative deaths and no long-term complications occurred, 2 patients were readmitted for increasing stridor and treated with nebulizations and improved. Conclusions Supraglottoplasty is an effective and safe treatment for symptomatic laryngomalacia and has the potential to provide better breathing and feeding outcomes. Among all the techniques, in our retrospective study, we found that successive apnea technique and coblator ablation is safe and effective methods in supraglottoplasty because it gives good exposure of supraglottis, no concern of airway fire, less collateral damage. The advantage is easy instrumentation with single wand for ablation, coagulation, and aspiration. Multicenter cooperative studies of comparison between coblator and conventional approaches would lend further evidence-based support for this surgical method.

Types of laryngomalacia in children: interrelationship between clinical course and comorbid conditions

The aim of this study was to: (1) find out whether laryngomalacia (LM) types are related to clinical course; (2) which patients with LM are at higher risk of other airway malacia [tracheomalacia (TM) and/or bronchomalacia (BM)]; and (3) evaluate the prevalence of LM in our region. Patients with established LM diagnosis and complete clinical and endoscopy records were enrolled. They were classified into different LM types according to classification based on the side of supraglottic obstruction. One hundred ten children were included. The most common LM appearance was type I—58 children, followed by combine types (I + II and I + III)—38. The other airway malacia were found in 47 patients: TM in 31, BM in 10, and TM with BM in 6. Other comorbidities (cardiac, neurological, and genetic disorders) were identified in 30 children. Patients with combine types of LM differ from those with single type of LM in terms of prematurity (13 vs 31 %, p = 0.04) and higher weight on the examination day (p = 0.006). Patients with other airway malacia differ from children with isolated LM in terms of prematurity (40 vs 13 %, p = 0.008), comorbidities (38 vs 19 %, p = 0.024), and lower weight on the examination day (p = 0.014). The prevalence of clinically relevant LM was one in 2600–3100 newborns. Clinical course of LM cannot be anticipated on the basis of solely endoscopic evaluation of the larynx. Comorbidities and prematurity increase the risk of other airway malacia. The prevalence of LM is relatively high in the middle-south part of Poland.

Treatment outcome of supraglottoplasty vs. wait-and-see policy in patients with laryngomalacia.

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.

Effort Dyspnea, if it is not Asthma? An Omega Epiglottis Case Report

Asthma is a chronic inflammatory disorder of the airways which is characterized by recurrent episodes of airway obstruction, associated with airway hyper responsiveness that leads to symptoms of dyspnea, wheezing, chest tightness, and/or coughing. Omega shaped epiglottis is a type of laryngomalacia which is a result of curling on itself of the epiglottis because of shortened aryepiglottic folds.

Primary Presentations of Laryngomalacia.

Laryngomalacia (LM) classically presents with stridor in early infancy but can present atypically with snoring and/or sleep-disordered breathing (S-SDB) or swallowing dysfunction (SwD). The epidemiology of these atypical presentations has not been established in the literature. To document the primary modes of presentation for LM in a consecutive series of children and to compare the characteristics of each subgroup. Retrospective case series in a single tertiary pediatric otolaryngology practice. Outpatient and surgical records were searched for patients diagnosed as having LM from 2002 to 2009. We included all children with endoscopically confirmed LM without prior documentation of the diagnosis (n = 88). Patients were investigated and managed according to the routine practice pattern of the senior author. The primary outcome measure was the proportion of the various primary presentations of LM. Age, sex, type of LM, management, and secondary diagnoses were also collected. Subgroup analysis was performed. Of 117 potentially eligible patients identified, 88 children had a confirmed diagnosis of LM and were thus included (1.9:1 male to female sex ratio; mean [SD] age, 14.5 [23.0] months; age range, 0.2-96.0 months). Fifty-six children (64%) presented primarily with awake stridor and variable respiratory distress; 22 (25%) with S-SDB; and 10 (11%) with SWD. The difference in mean (SD) age for each group was statistically significant by analysis of variance: stridor, 3.5 (2.8) months; S-SDB, 46.0 (27.2) months; and SwD, 4.8 (4.6) months (P < .001). By χ2 analysis, sex distribution was not significantly different between subgroups (P = .29), nor was the proportion of children who underwent supraglottoplasty (P = .07). The difference in proportion of types of LM between the stridor and atypical presentations was statistically significant (χ2P < .05), with type 1 LM predominating in children presenting with S-SDB. Because LM may present primarily with S-SDB and SwD in a significant proportion of children, the diagnosis must be considered in patients presenting with these upper airway complaints. The morphologic type of LM may vary by presentation.

Utility of sleep study in children with laryngomalacia

Introduction Laryngomalacia (LM) is one of the most frequent congenital laryngeal anomalies in children and it has been associated with sleep disorder. Our main objective was to describe the sleep study findings in children with LM using polysomnography (PSG) or respiratory polygraphy (RP). Materials and methods We studied 18 children diagnosed with laryngomalacia by flexible nasolaryngoscopy. We performed a sleep study: PSG or RP and complete medical history on all of them. Results 18 children were studied, 5 by PSG and 13 by RP. 11 (61.1%) of them were females, with a mean age of 3.38 ( ± 3.01) months and weight 4674 ( ± 1418) g. LM type 1 was present in 7 (38.9%), type 2 in 6 (33.3%) and type 3 in 5 (27.8%) children. Premature birth described 4 (22.2%) children. Stridor was the most frequent symptom, in 15 (83.3%) followed by feeding difficulties in 8 (44.4%). Apneas were referred in 7 (38.8%), intercostal retraction and regurgitation in 6 (33.3%). Gastroesophageal reflux disease was confirmed in 10 (55.5%) by pHmetry requiring surgery in 2 cases. Echocardiography was performed in 14 (77.8%) showing cardiac anomalies in 4 (22.2%). In the sleep study the mean values were: sleep efficiency 83% ( ± 5.85), NREM% 36.9 ( ± 11.1), REM% 30.5 ( ± 7.7) and indeterminate 32.4% ( ± 18.2), apnea-hypopnea index (AHI) 13.74 ( ± 10.90), hypopnea 30.5 ( ± 48.2), obstructive apneas 58.8 ( ± 67.3), central apneas 13.6 ( ± 20.8), cumulative percentage of time spent at saturation ± 4.72), mean oxygen saturation 96% ( ± 1.94) and heart rate 126 ( ± 14.24) bpm. 16 children (88.8%) were diagnosed with sleep-disordered breathing (SDB). Conclusion Our findings confirmed the necessity to do a sleep study in children with laryngomalacia, regardless of the type of laryngomalacia in nasolaryngoscopy. Acknowledgements The authors would like to thank Dra. Navazo Eguia and the Sleep Unit staff at the Universitary Hospital of Burgos for their help.

Severe Laryngomalacia: Management of 10 Cases with CO2 Laser

Objective1) Be able to quantify the prevalence of severe laryngomalacia in our department and evaluate the impact of postoperative CO2‐laser supraglottoplasty. 2) Determine if CO2‐laser supraglottoplasty laser is beneficial for patients with severe laryngomalacia.MethodRetrospective study. Ten patients diagnosed with severe laryngomalacia in our service from October 2001 to September 2011 who underwent unilateral or bilateral CO2‐laser supraglottoplasty. The main outcome measures were: type of laryngomalacia, resolution of clinically significant laryngomalacia, development of major complications, andlength of post‐operative hospital stay.ResultsA total of 10 pediatric patients aged 1 month to 14 years were enrolled. The mean age was 20.8 months. There were 6 men (60%) and 4 women (40%). Inspiratory stridor was the main clinical symptom (90%) and all children had significant relief of symptoms. Most common type of LM was the type I (60%). About 3 patients (30%) underwent a new surgery. None of them needed tracheotomy nor had major complications.ConclusionThe majority of patients undergoing supraglottoplasty do not present complications. CO2‐laser supraglottoplasty is a secure and effective treatment option for severe laryngomalacia. Furthermore the postoperative clinical follow‐up is an important factor for the successful treatment of laryngomalacia.

Secondary Airway Lesions in Laryngomalacia

To document the prevalence of secondary airway lesions (SALs) among children with laryngomalacia (LM). A cross-sectional observational study. Single practice in a tertiary care pediatric facility. Patients diagnosed with LM were initially identified from a prospectively kept surgical database. Patients with cardiac/large-vessel malformations, prematurity, repeated or prolonged intubations, acute infections, or prior airway surgery were excluded. Only children who had a full examination of the airway were included. Other associated diagnoses along with demographics, surgical intervention, and type of LM were included. Over an 8-year period, 1112 patients underwent laryngoscopy and bronchoscopy. A total of 108 consecutive cases were diagnosed with LM (78 primary diagnosis and 30 secondary diagnosis). After excluding 17 with disorders associated with large airway disease, 91 LM patients were included. The mean age was 553.23 days (ranging between 5 days and 15 years); 60 were boys and 31 were girls. The prevalence of SALs was 7.7% (95% confidence interval, 7.65-7.76; 7 children; 4 subglottic stenosis, 4 tracheomalacia, 1 bronchomalacia, and 1 choanal atresia). Fifty-nine patients underwent supraglottoplasties, while 1 patient had a tracheostomy. After accounting for conditions known to be associated with large airway lesions, the prevalence of SALs associated with laryngomalacia was much less than previously reported. The authors hypothesize that the upper-end figures are a reflection of highly select cohorts and the inclusion of patients with other pathology known to be associated with subglottic stenosis, tracheomalacia, and bronchomalacia and low thresholds for diagnosing mild subglottic stenosis.

Epiglottic suture for treatment of laryngomalacia

To present a technique for surgical management of laryngomalacia directed against the basic abnormality of the disease. Considering the cause-consequence relations of the abnormalities, we can distinguish two types of laryngomalacia. In the first, the basic abnormality is the pathological shape of the epiglottis: the epiglottis, which normally stands in an upright position, is characteristically excessively folded, restricting the supraglottic space directly as well as indirectly due to the proximity of the aryepiglottic folds that are attached to its lateral edges. In the second type the abnormality is the backward displacement (ptosis) of a normally shaped epiglottis. All other abnormalities are the consequences of these basic abnormalities. We present a new procedure, the epiglottic suture, to correct the pathological shape of the epiglottis. It is a suture placed transversely on the lingual surface of the epiglottis that unfolds the folded epiglottis and shifts apart the adjacent aryepiglottic folds. Prospective non-randomized study performed on eight severely distressed patients with laryngomalacia at the University Department for Otorhinolaryngology and Cervicofacial Surgery, Ljubljana, Slovenia. The epiglottic suture enabled normal breathing in all treated children without compromising the airway-protection function of the epiglottis. After an average follow up time of 19.12 months (minimum 7 months and maximum 27 months), we have not noticed any complications or deteriorations of breathing.

CO 2 laser supraglottoplasty for severe laryngomalacia: A study of symptomatic improvement

To investigate post-operative symptom improvement in patients with severe laryngomalacia. Severe laryngomalacia was diagnosed in 138 patients (average age of 6.97 months) by bronchoscopy. Laryngomalacia was defined by the direction of supraglottic collapse: type A (posterolateral), type B (complete), and type C (anterior). As multiple laryngomalacia types within an individual were common, patients were further categorized into group I (type A only), group II (type B or B+A), and group III (type C, C+A, or C+B+A). CO(2) laser supraglottoplasty was performed. Improvements in inspiratory stridor, suprasternal retraction, substernal retraction, feeding difficulty, choking, post-feeding vomit, failure to thrive, and cyanosis were investigated. The presence of a symptom was scored as 1, and the absence as 0. The total score of symptoms was calculated for each patient. General medical history, age at time of surgery, type of laryngomalacia, post-operative intubation period, duration in ICU and dates of postoperative admission were recorded. Overall symptom improvement was observed in 82.6% of patients, with statistically significant resolution evident in group III (B-value=0.79, 95% CI: -0.01, 1.59). Symptoms were not well improved in patients with cerebral palsy (n=32, B-value=-1.02, 95% CI: -1.80, -0.25; p<0.01). The two most improved symptoms were substernal retraction and suprasternal retraction, while the two least improved symptoms were choking and feeding difficulties. CO(2) laser supraglottoplasty is an effective treatment option for severe laryngomalacia, especially for group III laryngomalacia cases in the absence of cerebral palsy. It has the superiority of facilitating significant symptomatic resolution and reducing the post-operative complications.

Laryngomalacia and its treatment.

To determine 1) airway outcome of infants with laryngomalacia who do not undergo routine direct laryngoscopy (DL) and bronchoscopy (B), 2) the age at resolution of laryngomalacia, and, 3) outcome of supraglottoplasty as a function of the type of laryngomalacia and the presence of concomitant disease. Retrospective chart review. The records of all infants diagnosed with laryngomalacia by flexible fiberoptic laryngoscopy (FFL) between 1990 and 1998 in the Department of Otolaryngology--Head and Neck Surgery, University of Iowa (Iowa City, IA) were reviewed. The type of laryngomalacia was designated by a new classification scheme (types 1-3) based on the site of supraglottic obstruction and the type of supraglottoplasty indicated, should the patient later require surgical intervention. The log rank test was used to compare age at resolution and outcome between types of laryngomalacia and between infants with isolated laryngomalacia versus those with additional congenital abnormalities and/or severe neurological compromise. The type of laryngomalacia was evident in 48 of the 58 charts reviewed and included type 1 (57%), type 2 (15%), type 3 (13%), or combined types (15%). Twenty percent had severe neurological compromise and/or multiple congenital anomalies. The median time to resolution of stridor in these patients was not significantly delayed when compared with infants who had isolated airway anomalies (36 and 72 wk, respectively, vs. 36 wk for isolated laryngomalacia; P<.4). Time to resolution did not correlate with the type of laryngomalacia. In 22 infants, clinical symptoms or findings suggested a synchronous airway lesion, and direct laryngoscopy and bronchoscopy were performed. In 11 infants, a second airway lesion was diagnosed (in four cases by FFL and in 7 cases by direct laryngoscopy and bronchoscopy). Complications did not arise in infants who did not undergo direct laryngoscopy and bronchoscopy. Eleven infants with severe laryngomalacia required surgical intervention. The success of supraglottoplasty did not correlate with the type of laryngomalacia or the presence of other congenital anomalies. Routine direct laryngoscopy and bronchoscopy as part of the evaluation of laryngomalacia are not warranted. Performing these procedures should be based on clinical and physical evidence of a concomitant airway lesion. In general, laryngomalacia will resolve within the first year of life, even in children with multiple congenital anomalies and/or severe neurological compromise. The proposed classification scheme is advantageous in that it is simple and correlates the site of obstruction with the surgical procedure most likely to effect a cure, should the patient require a supraglottoplasty. Surgical management is necessary in approximately 15% to 20% of affected infants.

Autosomal dominant congenital laryngomalacia

A family is presented in which congenital stridor due to laryngomalacia was evident in 9 individuals through 3 generations. This report confirms the autosomal dominant transmission of at least one type of laryngomalacia.