Adult-onset laryngomalacia: case reports and review of management.

Laryngomalacia is a dynamic airway condition characterised by inward collapse of flaccid supraglottic structures during inspiration. Although the most common cause of stridor in the paediatric population, adult-onset laryngomalacia remains a rare entity and its management, challenging. Two cases of adult-onset laryngomalacia are reported. A review of the English literature is performed and additional publications identified by hand-searching relevant papers; 13 case reports/series comprising 28 cases of adult-onset laryngomalacia were identified, divided into two main groups: idiopathic (6/28) and acquired (22/28). The aetiology of the acquired form includes neurological, traumatic and iatrogenic. Reported therapeutic measures used are laser supraglottoplasty, epiglottopexy, partial epiglottidectomy, defunctioning tracheostomy and intubation whilst correcting the underlying cause. The majority of patients only required one therapeutic procedure (follow-up of 2-24 months). A strong index of suspicion is required to diagnose adult-onset laryngomalacia aided by in-office laryngoscopy. The rarity of this condition prevents management-based randomised controlled trials.

The effect of comorbidity on quality of life during radiotherapy in head and neck cancer.

OBJECTIVE: To identify the impact of comorbidity on quality of life during radiotherapy in head and neck cancer patients. STUDY DESIGN: Prospective assessment of quality of life and retrospective assessment of comorbidity. SUBJECTS AND METHODS: Patients' quality of life was assessed at the start and twice during radiation treatment with the University of Washington Quality of Life questionnaire. Comorbidity was assessed from the case notes of 91 patients with the Adult Comorbidity Evaluation-27 index. RESULTS: A mean comorbidity burden of 1.07 was found. Comorbid illnesses afflicted a little more than 60 percent of our cohort. Patients with moderate to severe comorbidity had statistically significantly worse quality of life at the start (P = 0.044) and midpoint of treatment (P = 0.005), but not at the end of treatment (P = 0.114). The magnitude of change of these scores after treatment was not influenced by comorbidity. CONCLUSION: On the basis of severity of decompensation, radiotherapy does not produce a differential impact on the quality of life.