Acid Suppression Does Not Improve Laryngomalacia Outcomes but Treatment for Oropharyngeal Dysphagia Might Be Protective.

OBJECTIVE: To determine whether the use of acid suppression and thickened feeds impact laryngomalacia outcomes in infants, including supraglottoplasty risk, time to supraglottoplasty, and hospitalization risk. STUDY DESIGN: We performed a retrospective cohort study to compare risk and time with supraglottoplasty and frequency and duration of hospitalizations for infants diagnosed with laryngomalacia at Boston Children's Hospital between January 1 and December 31, 2017. The primary outcomes were supraglottoplasty requirement, time to supraglottoplasty, and hospitalization risk. Multivariate analyses were performed to determine predictors of supraglottoplasty and hospitalization risk after adjusting for laryngomalacia severity and comorbidities in addition to propensity score adjustment. Kaplan-Meier curves were created to determine the impact of acid suppression use on time to supraglottoplasty. RESULTS: In total, 236 subjects with mean age 62.6 ± 4 days were included in the analysis; 55% were treated with acid suppression. Subjects treated with acid suppression had a greater risk of supraglottoplasty (hazard ratio 3.36, 95% CI 1.36-8.29, P = .009), shorter time to supraglottoplasty (5.64 ± 0.92 vs 7.98 ± 1.92 months, P = .006), and increased respiratory hospitalization risk (relative risk 1.97, 95% CI 1.01-3.85, 0.047), even after adjustment for covariates. Subjects receiving thickening had fewer respiratory hospitalization nights and longer time to supraglottoplasty (9.3 ± 1.7 vs 4.56 ± 0.73 months, P = .004), even after adjustment. CONCLUSIONS: Acid suppression use does not reduce the frequency of supraglottoplasty and related hospitalizations compared with untreated subjects. However, patients treated with thickening have decreased hospitalization and longer time to supraglottoplasty, suggesting that thickening of feeds may be a preferred intervention over acid suppression.

Complete polysomnographic parameters in infants with severe laryngomalacia prior to and after supraglottoplasty.

INTRODUCTION: Laryngomalacia is the most common congenital laryngeal anomaly. Because of supraglottic prolapse, laryngomalacia may be associated with obstructive sleep apnea (OSA) and sleep disturbances. The effects of OSA and sleep disorders in children include failure to thrive, cognitive and behavioral disturbances, cardiovascular compromise, and an association with sudden infant death syndrome. OBJECTIVE: To evaluate the presence of OSA and sleep disturbances in children with severe laryngomalacia through complete nocturnal polysomnography, as well as to establish the effects of supraglottoplasty in each of the polysomnographic parameters. RESULTS: Nine infants with severe laryngomalacia were included, all with a complete polysomnographic study prior to and after supraglottoplasty. The average age was 5.5 months. All patients presented an Apnea-Hypopnea Index (AHI) within the range of severe OSA. After supraglottoplasty, a significant reduction in AHI was found, from 34.87 ±â€¯20.34 to 9.44 ±â€¯5.28 after surgery (p: 0.022). Additionally, sleep efficiency had a significant increase, from 21.4% to 56.29% of total sleep time (p: 0.0013). All patients presented a significant decrease in obstructive apnea episodes (p < 0.0001), as well as in hypopnea episodes (p: 0.0154). The mean and minimum peripheral oxygen saturation (SpO2) had a significant increase after supraglottoplasty from 88.2% to 94.09% (p: 0.0002), and from 81.01% to 89.33% (p < 0.0001), respectively. CONCLUSION: Polysomnography (PSG) may provide better surgical sustenance in infants with severe laryngomalacia and OSA, as well as, serving as a monitoring tool of success. However, the surgical decision should not be reduced to polysomnographic results, and a good history and examination remain as the fundamental criteria.

Supraglottoplasty for laryngomalacia: The experience from Concepcion, Chile.

OBJECTIVE: To review the clinical manifestations and outcomes of supraglottoplasty in patients with moderate to severe laryngomalacia at Guillermo Grant Benavente Hospital between January 2015 and January 2017. METHODS: Retrospective study of patients with laryngomalacia who underwent CO2 laser supraglottoplasty at a tertiary referral center. A review of medical records of these patients was performed. Epidemiological data along with symptoms, comorbidities, morphological type of laryngomalacia, synchronous airway lesions, surgery outcomes and satisfaction of parents after the procedure were recorded. Surgical success was defined as the resolution of the criteria of severity of laryngomalacia. RESULTS: Twenty-four patients were operated, 1 was excluded due to prior tracheostomy. Twenty-three patients were included, the median age at the time of surgery was 5.5 months. All the patients had stridor, 87% presented feeding difficulties, 34.8 % had cyanosis and 21.7% had failure to thrive. Six cases had congenital anomalies and four cases had nongenetic comorbidities. Fifteen patients (65.2%) had synchronous airway lesions. 17.4% had type I laryngomalacia and 82.6% were type 2. The postoperative average hospital stay was 1.3 days. The average follow-up was 14 months and no complications were reported. The overall success rate of surgery was 95%. CONCLUSIONS: Patients with laryngomalacia and any symptom of severity should undergo a full airway evaluation, to rule out synchronous airway lesions, and supraglottoplasty if needed, as it has been shown to be a safe and effective technique for the management of these patients.

Supraglotoplastía láser en laringomalacia severa / Laser supraglottoplasty for severe laryngomalacia

Introducción: La laringomalacia es la causa más frecuente de estridor en lactantes, representando el 60%-70% de los defectos congénitos laríngeos. Entre 10%-20% de estos pacientes puede requerir tratamiento quirúrgico. Objetivo: Revisar las manifestaciones clínicas y los resultados de las supragloto-plastías en laringomalacia severa en nuestro hospital durante 2015. Material y método: Estudio descriptivo retrospectivo mediante revisión de fichas clínicas de pacientes sometidos a supraglotoplastía en el Hospital Guillermo Grant Benavente de Concepción en 2015. Resultados: Se intervinieron 11 pacientes siendo el promedio de edad, al momento de la cirugía, de 7,3 meses. Todos los pacientes tenían dificultad para alimentarse y el 45% además cianosis con la alimentación y el llanto, desaturaciones y pausas respiratorias. Cuatro casos portaban anomalías congénitas asociadas y el 73% presentó lesiones concomitantes de vía aérea, principalmente estenosis subglótica (64%). Los tipos morfológicos observados de laringomalacia fueron los tipos I y II con 27% y 73%, respectivamente. La tasa de éxito quirúrgico fue de 91%, sin necesidad de revisiones y no se presentaron complicaciones relacionadas al procedimiento. Conclusiones: La supraglotoplastía con láser es una técnica segura y efectiva para el tratamiento de laringomalacia severa. Los pacientes con laringomalacia severa debiesen ser sometidos a una revisión completa de vía aérea para evaluar otras comorbilidades.

Introduction: Laryngomalacia is the most common cause of stridor in infants, accounting for 60%-70% of laryngeal congenital defects. Between 10% to 20% of these patients may require surgical treatment. Aim: To review the clinical manifestations and outcomes of supraglottoplasties in severe laryngomalacia at our hospital during 2015. Material and method: Retrospective medical record review of children that underwent CO2 laser supraglottoplasty at Hospital Guillermo Grant Benavente in Concepcion during 2015. Results: Eleven patients were included in this study, the average age at the time of surgery was 7.3 months. All the patients had stridor associated with feeding difficulty and 45% of them also had cyanosis with feeding and crying, desaturations and respiratory pauses. Four cases had associated congenital anomalies and 73% of the patients had airway comorbidity, mostly subglottic stenosis (64%). All of ourpatients had types I and II laryngomalacia with 27% and 73%, respectively. The success rate of surgery was 91%, no patients required a revision supraglottoplasty and there were no complications related to the procedure. Conclusions: CO2 laser supraglottoplasty proved to be a safe and effective treatment for severe laryngomalacia. Patients with severe laryngomalacia should undergo a full airway revision under general anesthesia to assess airway comorbidity.

Surgical treatment of severe laryngomalacia: a retrospective study of 11 case.

UNLABELLED: Laryngomalacia is the most frequent congenital abnormality of the larynx, accounting for approximately 60-75% of congenital stridor cases. Despite its benign and self-limited aspects, 10% of cases require intervention. Currently, supraglottoplasty is considered the standard treatment of severe laryngomalacia. OBJECTIVE: To describe the experience of the authors in the surgical treatment of patients with severe laryngomalacia. METHODOLOGY: A retrospective study. METHOD: The medical records of 11 consecutive cases of severe laryngomalacia who underwent surgical treatment between 2003 and 2012 were analyzed for age, gender, symptoms, associated diseases, surgical technique employed, extubation time, surgical complications, length of hospital stay and clinical outcome. RESULTS: Of the 11 cases of severe laryngomalacia, six patients (54.5%) were operated with the use of CO2 laser and five patients (45.5%) were submitted to the cold technique. Only 1 patient (9.1%) required surgical reintervention. There were no cases of surgical complications. All patients had clinical improvement. CONCLUSION: Supraglottoplasty proved to be effective and safe in the treatment of severe laryngomalacia.

Tratamento cirurgico da laringomalacia grave: estudo retrospectivo de 11 casos / Surgical treatment of severe laryngomalacia: a retrospective study of 11 case

A laringomalácia é a anomalia congênita da laringe mais frequente, sendo responsável por cerca de 60% a 75% dos casos de estridor congênito. Apesar de seu curso benigno e autolimitado, 10% dos casos necessitam de intervenção. Atualmente, as supraglotoplastias são consideradas o tratamento padrão da laringomalácia grave. OBJETIVO: Descrever a experiência adquirida pelos autores no tratamento cirúrgico dos pacientes com laringomalácia grave. Metodologia: Estudo retrospectivo. MÉTODO: Os prontuários de 11 casos consecutivos de laringomalácia grave, submetidos ao tratamento cirúrgico entre 2003 e 2012, foram analisados quanto à idade, gênero, sintomas, doenças associadas, técnica cirúrgica adotada, tempo de extubação, complicações cirúrgicas, tempo de internação e evolução clínica. RESULTADOS: Dos 11 casos de laringomalácia grave, seis pacientes (54,5%) foram operados com o uso do laser de CO2 e em cinco pacientes (45,5%) foram realizadas a técnica a frio. Apenas um paciente (9,1%) necessitou reabordagem cirúrgica. Não foram observados casos de complicações cirúrgicas. Todos os pacientes apresentaram melhora clínica importante. CONCLUSÃO: A supraglotoplastia mostrou-se um procedimento eficaz e seguro no tratamento da laringomalácia grave. .

Laryngomalacia is the most frequent congenital abnormality of the larynx, accounting for approximately 60-75% of congenital stridor cases. Despite its benign and self-limited aspects, 10% of cases require intervention. Currently, supraglottoplasty is considered the standard treatment of severe laryngomalacia. OBJECTIVE: To describe the experience of the authors in the surgical treatment of patients with severe laryngomalacia. Methodology: A retrospective study. METHOD: The medical records of 11 consecutive cases of severe laryngomalacia who underwent surgical treatment between 2003 and 2012 were analyzed for age, gender, symptoms, associated diseases, surgical technique employed, extubation time, surgical complications, length of hospital stay and clinical outcome. RESULTS: Of the 11 cases of severe laryngomalacia, six patients (54.5%) were operated with the use of CO2 laser and five patients (45.5%) were submitted to the cold technique. Only 1 patient (9.1%) required surgical reintervention. There were no cases of surgical complications. All patients had clinical improvement. CONCLUSION: Supraglottoplasty proved to be effective and safe in the treatment of severe laryngomalacia. .

Supraglotoplastía asistida con microdebridador en pacientes con síndrome de Pierre Robin y laringomalacia severa / Assisted endoscopic microdebrider supraglottoplasty in patients with Pierre Robin syndrome and severe laryngomalacia

Se presenta el caso de una paciente recién nacida de término portadora de un síndrome de Pierre Robin asociada a laringomalacia severa que requirió resolución quirúrgica para estabilización de su vía aérea superior Se presenta la experiencia clínica en el uso de microdebridador para realización de supraglotoplastía como una novedosa alternativa en el tratamiento quirúrgico de este tipo de pacientes y se realiza revisión de la literatura respecto de esta técnica.

Pierre Robin syndrome is a triad formed by micrognathia, and cleft palate glossoptosis. His association with laryngomalacia is not set however determining the coexistence of these two diseases and their severity is of utmost importance as they condition the prognosis of a patient with Pierre Robin syndrome. Currently one of the surgical techniques used in patients with severe laryngomalacia, is assisted endoscopic microdebrider supraglottoplasty. In the ENT unit of the Hospital Luis Calvo Mackenna, this procedure is being implemented in order to give our patients a safe and effective treatment option for their pathology.

Tratamento cirúrgico de laringomalácia: casuística de hospital pediátrico terciário / Laryngomalacia surgery: a series from a tertiary pediatric hospital

Laringomalácia é o colapso supraglótico durante a inspiração; é responsável por até 75% dos casos de estridor em crianças de até 30 meses. O achado característico é estridor inspiratório; até 20% dos pacientes apresentam quadros graves, sendo necessária intervenção cirúrgica. A supraglotoplastia é o procedimento de escolha e se considera a presença de comorbidades como o maior fator prognóstico para o sucesso da cirurgia. OBJETIVOS: Descrever a casuística de hospital pediátrico terciário, índices de sucesso e analisando fatores prognósticos cirúrgicos. MÉTODO: Estudo de coorte retrospectivo. Incluídos 20 pacientes submetidos à supraglotoplastia no período de julho de 2007 a maio de 2011. RESULTADOS: Dos 20 pacientes, 13 (65%) eram do sexo masculino; a média de idade no procedimento foi de 6,32 meses. Na endoscopia, 12 apresentavam associações de tipos de laringomalácia, 40% apresentavam faringomalácia associada e três apresentavam também traqueomalácia. Treze crianças apresentavam laringomalácia isolada e sete pacientes apresentavam doença do refluxo gastroesofágico. Quinze (75%) pacientes foram submetidos à ressecção de pregas ariepiglóticas. Após o procedimento, 11 pacientes ficaram assintomáticos e dois necessitaram traqueostomia. A presença de comorbidades foi a variável preditora de desfecho desfavorável pós-operatório (p = 0,034). CONCLUSÃO: A supraglotoplastia é um procedimento seguro para tratamento de laringomalácia em casos selecionados.

Laryngomalacia is the condition responsible for 75% of the cases of stridor in children aged up to 30 months, in which there is supraglottic collapse during inhalation. Inspiratory stridor is a characteristic telltale. As many as 20% of the patients are severely affected and require surgery. Supraglottoplasty is the procedure of choice and the presence of comorbidities is the most relevant prognostic factor for surgery success. OBJECTIVE: To describe a series in a tertiary pediatric hospital, its success rates, and surgery prognostic factors. METHOD: This retrospective cohort study enrolled 20 patients submitted to supraglottoplasty between July 2007 and May 2011. RESULTS: Thirteen (65%) patients were males; mean age at the time of the procedure was 6.32 months. Endoscopic examination showed that 12 subjects had combined forms of laryngomalacia, 40% had associated pharyngomalacia, and three also had tracheomalacia. Thirteen subjects had isolated laryngomalacia and seven had gastroesophageal reflux disease. Fifteen (75%) patients underwent aryepiglottic fold resection. After the procedure, eleven patients were asymptomatic and two required tracheostomy. Presence of comorbidities was the strongest predictor of unfavorable postoperative outcome (p = 0.034). CONCLUSION: Supraglottoplasty is a safe therapeutical procedure for select patients with laryngomalacia.

Laryngomalacia surgery: a series from a tertiary pediatric hospital.

UNLABELLED: Laryngomalacia is the condition responsible for 75% of the cases of stridor in children aged up to 30 months, in which there is supraglottic collapse during inhalation. Inspiratory stridor is a characteristic telltale. As many as 20% of the patients are severely affected and require surgery. Supraglottoplasty is the procedure of choice and the presence of comorbidities is the most relevant prognostic factor for surgery success. OBJECTIVE: To describe a series in a tertiary pediatric hospital, its success rates, and surgery prognostic factors. METHOD: This retrospective cohort study enrolled 20 patients submitted to supraglottoplasty between July 2007 and May 2011. RESULTS: Thirteen (65%) patients were males; mean age at the time of the procedure was 6.32 months. Endoscopic examination showed that 12 subjects had combined forms of laryngomalacia, 40% had associated pharyngomalacia, and three also had tracheomalacia. Thirteen subjects had isolated laryngomalacia and seven had gastroesophageal reflux disease. Fifteen (75%) patients underwent aryepiglottic fold resection. After the procedure, eleven patients were asymptomatic and two required tracheostomy. Presence of comorbidities was the strongest predictor of unfavorable postoperative outcome (p = 0.034). CONCLUSION: Supraglottoplasty is a safe therapeutical procedure for select patients with laryngomalacia.