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Laryngomalacia: is there an evidence base for management?

Published online by Cambridge University Press:  25 October 2017

C McCaffer ,
K Blackmore  and
L M Flood
C McCaffer
Affiliation:
ENT Department, James Cook University Hospital, Middlesbrough, UK
K Blackmore
Affiliation:
ENT Department, James Cook University Hospital, Middlesbrough, UK
L M Flood*
Affiliation:
ENT Department, James Cook University Hospital, Middlesbrough, UK
*
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
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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.

Keywords

LaryngomalaciaDiagnosisSurgeryReviewSystematic
Type
Review Articles
Information
The Journal of Laryngology & Otology , Volume 131 , Issue 11 , November 2017 , pp. 946 - 954
Copyright
Copyright © JLO (1984) Limited 2017 

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References

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;327:1459–61Google Scholar
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;131:290–7Google Scholar
3 Jackson, C, Jackson, CL. Diseases and Injuries of the Larynx. New York: Macmillan, 1942;63–9Google Scholar
4 Jani, P, Koltai, P, Ochi, JW, Bailey, CM. Surgical treatment of laryngomalacia. J Laryngol Otol 1991;105:1040–5Google Scholar
5 Mckenzie, D. Arytaenoid stridor. J Laryngol Otol 1919;34:449–??CrossRefGoogle Scholar
6 Toynton, SC, Saunders, MW, Bailey, CM. Aryepiglottoplasty for laryngomalacia: 100 consecutive cases. J Laryngol Otol 2001;115:35–8Google Scholar
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 CrossRefGoogle Scholar
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]Google Scholar
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;50:1368–73Google Scholar
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;126:491–500 Google Scholar
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;142:665–71Google Scholar
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;126:1246–55Google Scholar
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;87:18–27 Google Scholar
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;120:116–22Google Scholar
15 Hartl, TT, Chadha, NK. A systematic review of laryngomalacia and acid reflux. Otolaryngol Head Neck Surg 2012;147:619–26Google Scholar
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;83:78–83 Google Scholar
17 Preciado, D, Zalzal, G. A systematic review of supraglottoplasty outcomes. Arch Otolaryngol Head Neck Surg 2012;138:718–21Google Scholar
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;130:1412–18Google Scholar
19 Faria, J, Behar, P. Medical and surgical management of congenital laryngomalacia: a case-control study. Otolaryngol Head Neck Surg 2014;151:845–51Google Scholar
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;273:1507–13Google Scholar
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;75:824–9Google Scholar
22 Reddy, DK, Matt, BH. Unilateral vs. bilateral supraglottoplasty for severe laryngomalacia in children. Arch Otolaryngol Head Neck Surg 2001;127:694–9Google Scholar
23 Walner, DL, Neumann, DB, Hamming, KK, Miller, RP. Supraglottoplasty in infants: a staged approach. Ann Otol Rhinol Laryngol 2015;124:803–7CrossRefGoogle ScholarPubMed
24 Meier, JD, Nguyen, SA, White, DR. Improved growth curve measurements after supraglottoplasty. Laryngoscope 2011;121:1574–7Google Scholar
25 Shah, UK, Wetmore, RF. Laryngomalacia: a proposed classification form. Int J Pediatr Otorhinolaryngol 1998;46:21–6Google Scholar
26 Kay, DJ, Goldsmith, AJ. Laryngomalacia: a classification system and surgical treatment strategy. Ear Nose Throat J 2006;85:328–31, 336Google Scholar
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;71:889–95Google Scholar
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;140:927–33Google Scholar
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;115:894–6Google Scholar
30 Loizou, P, Haloob, N, Evgeniou, E. Per-oral flexible laryngoscopy in awake neonates and infants: the ‘pacifier’ technique. J Laryngol Otol 2014;128:169–70Google Scholar
31 Huntley, C, Carr, MM. Evaluation of the effectiveness of airway fluoroscopy in diagnosing patients with laryngomalacia. Laryngoscope 2010;120:1430–4Google Scholar
32 Adil, E, Rager, T, Carr, M. Location of airway obstruction in term and preterm infants with laryngomalacia. Am J Otolaryngol 2012;33:437–40Google Scholar
33 Weinstein, JE, Lawlor, CM, Wu, EL, Rodriguez, KH. Utility of polysomnography in determination of laryngomalacia severity. Int J Pediatr Otorhinolaryngol 2017;93:145–9CrossRefGoogle ScholarPubMed
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;150:677–83Google Scholar
35 Simons, JP, Greenberg, LL, Mehta, DK, Fabio, A, Maguire, RC, Mandell, DL. Laryngomalacia and swallowing function in children. Laryngoscope 2016;126:478–84CrossRefGoogle ScholarPubMed
36 Dickson, JM, Richter, GT, Meinzen-Derr, J, Rutter, MJ, Thompson, DM. Secondary airway lesions in infants with laryngomalacia. Ann Otol Rhinol Laryngol 2009;118:37–43 Google Scholar
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;124:808–13Google Scholar
38 Edmondson, NE, Bent, JP 3rd, Chan, C. Laryngomalacia: the role of gender and ethnicity. Int J Pediatr Otorhinolaryngol 2011;75:1562–4CrossRefGoogle ScholarPubMed
39 Wright, CT, Goudy, SL. Congenital laryngomalacia: symptom duration and need for surgical intervention. Ann Otol Rhinol Laryngol 2012;121:57–60 Google Scholar
40 Garritano, FG, Carr, MM. Characteristics of patients undergoing supraglottoplasty for laryngomalacia. Int J Pediatr Otorhinolaryngol 2014;78:1095–100Google Scholar
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;274:367–74Google Scholar
42 Groblewski, JC, Shah, RK, Zalzal, GH. Microdebrider-assisted supraglottoplasty for laryngomalacia. Ann Otol Rhinol Laryngol 2009;118:592–7Google Scholar
43 Fordham, MT, Potter, SM, White, DR. Postoperative management following supraglottoplasty for severe laryngomalacia. Laryngoscope 2013;123:3206–10Google Scholar
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;141:704–9Google Scholar
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;78:1485–8Google Scholar
46 Day, KE, Discolo, CM, Meier, JD, Wolf, BJ, Halstead, LA, White, DR. Risk factors for supraglottoplasty failure. Otolaryngol Head Neck Surg 2012;146:298–301 Google Scholar
47 Durvasula, VS, Lawson, BR, Bower, CM, Richter, GT. Supraglottoplasty outcomes in neurologically affected and syndromic children. JAMA Otolaryngol Head Neck Surg 2014;140:704–11Google Scholar
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;150:292–9Google Scholar
49 Cockerill, CC, Frisch, CD, Rein, SE, Orvidas, LJ. Supraglottoplasty outcomes in children with Down syndrome. Int J Pediatr Otorhinolaryngol 2016;87:87–90 Google Scholar
50 Czechowicz, JA, Chang, KW. Catch-up growth in infants with laryngomalacia after supraglottoplasty. Int J Pediatr Otorhinolaryngol 2015;79:1333–6Google Scholar
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;94:320–8Google Scholar
52 Anderson de Moreno, LC, Matt, BH. The effects of prematurity on incidence of aspiration following supraglottoplasty for laryngomalacia. Laryngoscope 2014;124:777–80Google Scholar
53 Richter, GT, Wootten, CT, Rutter, MJ, Thompson, DM. Impact of supraglottoplasty on aspiration in severe laryngomalacia. Ann Otol Rhinol Laryngol 2009;118:259–66Google Scholar
54 Schroeder, JW Jr, Thakkar, KH, Poznanovic, SA, Holinger, LD. Aspiration following CO(2) laser-assisted supraglottoplasty. Int J Pediatr Otorhinolaryngol 2008;72:985–90Google Scholar
55 Rastatter, JC, Schroeder, JW, Hoff, SR, Holinger, LD. Aspiration before and after supraglottoplasty regardless of technique. Int J Otolaryngol 2010;2010:912814 Google Scholar
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;78:1883–5Google Scholar
57 Eustaquio, M, Lee, EN, Digoy, GP. Feeding outcomes in infants after supraglottoplasty. Otolaryngol Head Neck Surg 2011;145:818–22Google Scholar
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;86:256–61Google Scholar
59 Ramprasad, VH, Ryan, MA, Farjat, AE, Eapen, RJ, Raynor, EM. Practice patterns in supraglottoplasty and perioperative care. Int J Pediatr Otorhinolaryngol 2016;86:118–23CrossRefGoogle ScholarPubMed
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;78:583–7Google Scholar
61 Thottam, PJ, Simons, JP, Choi, S, Maguire, R, Mehta, DK. Clinical relevance of quality of life in laryngomalacia. Laryngoscope 2016;126:1232–5Google Scholar