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Laryngomalacia: is there an evidence base for management?

  • C McCaffer (a1), K Blackmore (a1) and L M Flood (a1)
Abstract
Abstract Background:

The advent of supraglottoplasty clearly has transformed the surgical management of severe laryngomalacia. The condition, however, generally runs a milder course, with spontaneous resolution the norm.

Objectives:

To identify gaps in the knowledge and identify topics for future study.

Method:

Systematic review of the literature.

Results:

The literature suggests that there is a range of abnormalities leading to the typical collapsing upper airway, and that neurological disease, other airway abnormalities, syndromes and gastroesophageal reflux all contribute to disease severity and influence outcomes. The procedures involved in supraglottoplasty are rarely specified, the indications for surgery are vaguely defined and the role of medical therapy is unclear.

Conclusion:

Every review article or survey of opinion suggests that there is still a marked variation in individual practice and a lack of consensus.

Copyright
Corresponding author
Address for correspondence: Mr Liam M Flood, ENT Department, James Cook University Hospital, Marton Rd, Middlesbrough TS4 3BW, UK E-mail: Liam.flood@nhs.net
References
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1 Smith GC, Pell JP. Parachute use to prevent death and major trauma related to gravitational challenge: systematic review of randomised controlled trials. BMJ 2003;327:1459–61
2 Ellinas A, Jervis P, Kenyon G, Flood LM. Endoscopic sphenopalatine artery ligation for acute idiopathic epistaxis. Do anatomical variation and a limited evidence base raise questions regarding its place in management? J Laryngol Otol 2017;131:290–7
3 Jackson C, Jackson CL. Diseases and Injuries of the Larynx. New York: Macmillan, 1942;63–9
4 Jani P, Koltai P, Ochi JW, Bailey CM. Surgical treatment of laryngomalacia. J Laryngol Otol 1991;105:1040–5
5 Mckenzie D. Arytaenoid stridor. J Laryngol Otol 1919;34:449–??
6 Toynton SC, Saunders MW, Bailey CM. Aryepiglottoplasty for laryngomalacia: 100 consecutive cases. J Laryngol Otol 2001;115:35–8
7 Shamseer L, Moher D, Clarke M, Ghersi D, Liberati A, Petticrew M et al. Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015: elaboration and explanation. BMJ 2015;349:g7647
8 National Institute for Health and Care Excellence. Assessing the quality of the evidence. In: https://www.nice.org.uk/process/pmg4/chapter/reviewing-the-scientific-evidence#assessing-the-quality-of-the-evidence [20 September 2017]
9 van der Heijden M, Dikkers FG, Halmos GB. The Groningen laryngomalacia classification system--based on systematic review and dynamic airway changes. Pediatr Pulmonol 2015;50:1368–73
10 Manickam PV, Shott SR, Boss EF, Cohen AP, Meinzen-Derr JK, Amin RS et al. Systematic review of site of obstruction identification and non-CPAP treatment options for children with persistent pediatric obstructive sleep apnea. Laryngoscope 2016;126:491500
11 Farhood Z, Ong AA, Nguyen SA, Gillespie MB, Discolo CM, White DR. Objective outcomes of supraglottoplasty for children with laryngomalacia and obstructive sleep apnea: a meta-analysis. JAMA Otolaryngol Head Neck Surg 2016;142:665–71
12 Camacho M, Dunn B, Torre C, Sasaki J, Gonzales R, Liu SY et al. Supraglottoplasty for laryngomalacia with obstructive sleep apnea: a systematic review and meta-analysis. Laryngoscope 2016;126:1246–55
13 Lee CF, Hsu WC, Lee CH, Lin MT, Kang KT. Treatment outcomes of supraglottoplasty for pediatric obstructive sleep apnea: a meta-analysis. Int J Pediatr Otorhinolaryngol 2016;87:1827
14 May JG, Shah P, Lemonnier L, Bhatti G, Koscica J, Coticchia AM. Systematic review of endoscopic airway findings in children with gastroesophageal reflux disease. Ann Otol Rhinol Laryngol 2011;120:116–22
15 Hartl TT, Chadha NK. A systematic review of laryngomalacia and acid reflux. Otolaryngol Head Neck Surg 2012;147:619–26
16 Isaac A, Zhang H, Soon SR, Campbell S, El-Hakim H. A systematic review of the evidence on spontaneous resolution of laryngomalacia and its symptoms. Int J Pediatr Otorhinolaryngol 2016;83:7883
17 Preciado D, Zalzal G. A systematic review of supraglottoplasty outcomes. Arch Otolaryngol Head Neck Surg 2012;138:718–21
18 Sivan Y, Ben-Ari J, Soferman R, DeRowe A. Diagnosis of laryngomalacia by fiberoptic endoscopy: awake compared with anesthesia-aided technique. J Chest 2006;130:1412–18
19 Faria J, Behar P. Medical and surgical management of congenital laryngomalacia: a case-control study. Otolaryngol Head Neck Surg 2014;151:845–51
20 van der Heijden M, Dikkers FG, Halmos GB. Treatment outcome of supraglottoplasty vs. wait-and-see policy in patients with laryngomalacia. Eur Arch Otorhinolaryngol 2016;273:1507–13
21 Soong WJ, Shiao AS, Jeng MJ, Lee YS, Tsao PC, Yang CF et al. Comparison between rigid and flexible laser supraglottoplasty in the treatment of severe laryngomalacia in infants. Int J Pediatr Otorhinolaryngol 2011;75:824–9
22 Reddy DK, Matt BH. Unilateral vs. bilateral supraglottoplasty for severe laryngomalacia in children. Arch Otolaryngol Head Neck Surg 2001;127:694–9
23 Walner DL, Neumann DB, Hamming KK, Miller RP. Supraglottoplasty in infants: a staged approach. Ann Otol Rhinol Laryngol 2015;124:803–7
24 Meier JD, Nguyen SA, White DR. Improved growth curve measurements after supraglottoplasty. Laryngoscope 2011;121:1574–7
25 Shah UK, Wetmore RF. Laryngomalacia: a proposed classification form. Int J Pediatr Otorhinolaryngol 1998;46:21–6
26 Kay DJ, Goldsmith AJ. Laryngomalacia: a classification system and surgical treatment strategy. Ear Nose Throat J 2006;85:328–31, 336
27 Lee KS, Chen BN, Yang CC, Chen YC. CO2 laser supraglottoplasty for severe laryngomalacia: a study of symptomatic improvement. Int J Pediatr Otorhinolaryngol 2007;71:889–95
28 Erickson B, Cooper T, El-Hakim H. Factors associated with the morphological type of laryngomalacia and prognostic value for surgical outcomes. JAMA Otolaryngol Head Neck Surg 2014;140:927–33
29 Kayaykar R, Gray RF. Per oral awake flexible fibre-optic laryngoscopy in the investigation of children with stridor without respiratory distress. J Laryngol Otol 2001;115:894–6
30 Loizou P, Haloob N, Evgeniou E. Per-oral flexible laryngoscopy in awake neonates and infants: the ‘pacifier’ technique. J Laryngol Otol 2014;128:169–70
31 Huntley C, Carr MM. Evaluation of the effectiveness of airway fluoroscopy in diagnosing patients with laryngomalacia. Laryngoscope 2010;120:1430–4
32 Adil E, Rager T, Carr M. Location of airway obstruction in term and preterm infants with laryngomalacia. Am J Otolaryngol 2012;33:437–40
33 Weinstein JE, Lawlor CM, Wu EL, Rodriguez KH. Utility of polysomnography in determination of laryngomalacia severity. Int J Pediatr Otorhinolaryngol 2017;93:145–9
34 Tanphaichitr A, Tanphaichitr P, Apiwattanasawee P, Brockbank J, Rutter MJ, Simakajornboon N. Prevalence and risk factors for central sleep apnea in infants with laryngomalacia. Otolaryngol Head Neck Surg 2014;150:677–83
35 Simons JP, Greenberg LL, Mehta DK, Fabio A, Maguire RC, Mandell DL. Laryngomalacia and swallowing function in children. Laryngoscope 2016;126:478–84
36 Dickson JM, Richter GT, Meinzen-Derr J, Rutter MJ, Thompson DM. Secondary airway lesions in infants with laryngomalacia. Ann Otol Rhinol Laryngol 2009;118:3743
37 Hseu A, Recko T, Jennings R, Nuss R. Upper airway anomalies in congenital tracheoesophageal fistula and esophageal atresia patients. Ann Otol Rhinol Laryngol 2015;124:808–13
38 Edmondson NE, Bent JP 3rd, Chan C. Laryngomalacia: the role of gender and ethnicity. Int J Pediatr Otorhinolaryngol 2011;75:1562–4
39 Wright CT, Goudy SL. Congenital laryngomalacia: symptom duration and need for surgical intervention. Ann Otol Rhinol Laryngol 2012;121:5760
40 Garritano FG, Carr MM. Characteristics of patients undergoing supraglottoplasty for laryngomalacia. Int J Pediatr Otorhinolaryngol 2014;78:1095–100
41 Reinhard A, Gorostidi F, Leishman C, Monnier P, Sandu K. Laser supraglottoplasty for laryngomalacia; a 14 year experience of a tertiary referral center. Eur Arch Otorhinolaryngol 2017;274:367–74
42 Groblewski JC, Shah RK, Zalzal GH. Microdebrider-assisted supraglottoplasty for laryngomalacia. Ann Otol Rhinol Laryngol 2009;118:592–7
43 Fordham MT, Potter SM, White DR. Postoperative management following supraglottoplasty for severe laryngomalacia. Laryngoscope 2013;123:3206–10
44 Albergotti WG, Sturm JJ, Stapleton AS, Simons JP, Mehta DK, Chi DH. Predictors of intensive care unit stay after pediatric supraglottoplasty. JAMA Otolaryngol Head Neck Surg 2015;141:704–9
45 Douglas CM, Shafi A, Higgins G, Blackmore K, Wynne DM, Kubba H et al. Risk factors for failure of supraglottoplasty. Int J Pediatr Otorhinolaryngol 2014;78:1485–8
46 Day KE, Discolo CM, Meier JD, Wolf BJ, Halstead LA, White DR. Risk factors for supraglottoplasty failure. Otolaryngol Head Neck Surg 2012;146:298301
47 Durvasula VS, Lawson BR, Bower CM, Richter GT. Supraglottoplasty outcomes in neurologically affected and syndromic children. JAMA Otolaryngol Head Neck Surg 2014;140:704–11
48 Durvasula VS, Lawson BR, Bower CM, Richter GT. Supraglottoplasty in premature infants with laryngomalacia: does gestation age at birth influence outcomes? Otolaryngol Head Neck Surg 2014;150:292–9
49 Cockerill CC, Frisch CD, Rein SE, Orvidas LJ. Supraglottoplasty outcomes in children with Down syndrome. Int J Pediatr Otorhinolaryngol 2016;87:8790
50 Czechowicz JA, Chang KW. Catch-up growth in infants with laryngomalacia after supraglottoplasty. Int J Pediatr Otorhinolaryngol 2015;79:1333–6
51 Anderson de Moreno LC, Burgin SJ, Matt BH. The incidence of postoperative aspiration among children undergoing supraglottoplasty for laryngomalacia. Ear Nose Throat J 2015;94:320–8
52 Anderson de Moreno LC, Matt BH. The effects of prematurity on incidence of aspiration following supraglottoplasty for laryngomalacia. Laryngoscope 2014;124:777–80
53 Richter GT, Wootten CT, Rutter MJ, Thompson DM. Impact of supraglottoplasty on aspiration in severe laryngomalacia. Ann Otol Rhinol Laryngol 2009;118:259–66
54 Schroeder JW Jr, Thakkar KH, Poznanovic SA, Holinger LD. Aspiration following CO(2) laser-assisted supraglottoplasty. Int J Pediatr Otorhinolaryngol 2008;72:985–90
55 Rastatter JC, Schroeder JW, Hoff SR, Holinger LD. Aspiration before and after supraglottoplasty regardless of technique. Int J Otolaryngol 2010;2010:912814
56 Chun RH, Wittkopf M, Sulman C, Arvedson J. Transient swallowing dysfunction in typically developing children following supraglottoplasty for laryngomalacia. Int J Pediatr Otorhinolaryngol 2014;78:1883–5
57 Eustaquio M, Lee EN, Digoy GP. Feeding outcomes in infants after supraglottoplasty. Otolaryngol Head Neck Surg 2011;145:818–22
58 Carter J, Rahbar R, Brigger M, Chan K, Cheng A, Daniel SJ et al. International Pediatric ORL Group (IPOG) laryngomalacia consensus recommendations. Int J Pediatr Otorhinolaryngol 2016;86:256–61
59 Ramprasad VH, Ryan MA, Farjat AE, Eapen RJ, Raynor EM. Practice patterns in supraglottoplasty and perioperative care. Int J Pediatr Otorhinolaryngol 2016;86:118–23
60 Kilpatrick LA, Boyette JR, Hartzell LD, Norton JA, Boswell JB, Bower CM et al. Prospective quality of life assessment in congenital laryngomalacia. Int J Pediatr Otorhinolaryngol 2014;78:583–7
61 Thottam PJ, Simons JP, Choi S, Maguire R, Mehta DK. Clinical relevance of quality of life in laryngomalacia. Laryngoscope 2016;126:1232–5
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The Journal of Laryngology & Otology
  • ISSN: 0022-2151
  • EISSN: 1748-5460
  • URL: /core/journals/journal-of-laryngology-and-otology
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