Skip to main content Accessibility help

Laryngomalacia: is there an evidence base for management?

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



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.


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


Systematic review of the literature.


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.


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


Corresponding author

Address for correspondence: Mr Liam M Flood, ENT Department, James Cook University Hospital, Marton Rd, Middlesbrough TS4 3BW, UK E-mail:


Hide All
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: [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
Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

The Journal of Laryngology & Otology
  • ISSN: 0022-2151
  • EISSN: 1748-5460
  • URL: /core/journals/journal-of-laryngology-and-otology
Please enter your name
Please enter a valid email address
Who would you like to send this to? *



Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed