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Mills JF, Monaghan NP, Nguyen SA, Nguyen CL, Clemmens CS, Carroll WW, Pecha PP, White DR. Characteristics and outcomes of interventions for pediatric laryngomalacia: A systematic review with meta-analysis. Int J Pediatr Otorhinolaryngol 2024; 178:111896. [PMID: 38364547 DOI: 10.1016/j.ijporl.2024.111896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Revised: 02/07/2024] [Accepted: 02/11/2024] [Indexed: 02/18/2024]
Abstract
OBJECTIVES To analyze characteristics of children treated for laryngomalacia to determine predictive factors and provide an updated meta-analysis on outcomes. METHODS A systematic review was conducted according to PRISMA guidelines from inception to May 2, 2023, using CINAHL, PubMed, and Scopus databases. Study screening, data extraction, quality rating, and risk of bias assessment were performed by 2 independent reviewers. Data were meta-analyzed using fixed-/random-effects model to derive continuous measures (mean), proportions (%), and mean difference (Δ) with 95% confidence interval (CI). RESULTS 100 articles were identified with information on outcomes of pediatric patients with laryngomalacia (N = 18,317). The mean age was 10.6 months (range: 0 to 252, 95%CI: 9.6 to 11.6, p = 0.00) with a 1.4:1 male to female ratio. Many patients presented with stridor (87.9%, 95% CI: 69.8 to 98.4), and the most common comorbidity at time of diagnosis was gastroesophageal reflux disease (48.8%, 95%CI: 40.9 to 56.8). Based on the patient population included in our analysis, 86.1% received supraglottoplasty (95% CI: 78.7 to 92.1). A total of 73.6% (95% CI: 65.5 to 81.0) had reported complete resolution of symptoms. For patients with a concurrent diagnosis of sleep disordered breathing receiving supraglottoplasty, the apnea-hypopnea index improved with a mean difference of -10.0 (95%CI: 15.6 to -4.5) events per hour post-treatment. CONCLUSIONS Laryngomalacia continues to be a common problem in the pediatric population. Supraglottoplasty remains an effective treatment option leading to symptomatic improvement in many cases. For those with concurrent sleep disordered breathing, supraglottoplasty lowers the apnea-hypopnea index.
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Affiliation(s)
- John F Mills
- Department of Otolaryngology - Head and Neck Surgery, Medical University of South Carolina, 135 Rutledge Avenue, Charleston, SC, 29425, USA; Albany Medical College, 47 New Scotland Avenue, Albany, NY, 12208, USA
| | - Neil P Monaghan
- Department of Otolaryngology - Head and Neck Surgery, Medical University of South Carolina, 135 Rutledge Avenue, Charleston, SC, 29425, USA
| | - Shaun A Nguyen
- Department of Otolaryngology - Head and Neck Surgery, Medical University of South Carolina, 135 Rutledge Avenue, Charleston, SC, 29425, USA.
| | | | - Clarice S Clemmens
- Department of Otolaryngology - Head and Neck Surgery, Medical University of South Carolina, 135 Rutledge Avenue, Charleston, SC, 29425, USA
| | - William W Carroll
- Department of Otolaryngology - Head and Neck Surgery, Medical University of South Carolina, 135 Rutledge Avenue, Charleston, SC, 29425, USA
| | - Phayvanh P Pecha
- Department of Otolaryngology - Head and Neck Surgery, Medical University of South Carolina, 135 Rutledge Avenue, Charleston, SC, 29425, USA
| | - David R White
- Department of Otolaryngology - Head and Neck Surgery, Medical University of South Carolina, 135 Rutledge Avenue, Charleston, SC, 29425, USA
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Gagnon C, Bérubé S, Sauthier M, Rouillard-Bazinet N, Bergeron M. Evaluating the Need for Intensive Care Admission After Supraglottoplasty for Severe Laryngomalacia. Laryngoscope 2024; 134:466-470. [PMID: 37334868 DOI: 10.1002/lary.30813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 05/21/2023] [Accepted: 05/30/2023] [Indexed: 06/21/2023]
Abstract
OBJECTIVE Postoperative airway concerns persist despite a low rate of post-supraglottoplasty complications for children with laryngomalacia. The objective of this study is to determine the factors associated with the need for intensive care unit (ICU) admission following supraglottoplasty. METHODS A 7-year retrospective cohort analysis was conducted between 2014 and 2021. A patient requiring ICU level of care was defined as the use of respiratory support such as intubation, positive pressure ventilation, high-flow nasal cannula, or multiple doses of nebulized epinephrine. RESULTS About 134 medical charts were reviewed; 12 patients were excluded because of concurrent surgery. Age at the time of surgery was 2.8 (4.3) months (median [interquartile range]). About 33 (27.0%) ultimately required ICU-level care. Prematurity (odds ratio [OR] 13.8), neurological condition (OR ∞), American Society of Anesthesiology class 3-4 (OR 6.5), and younger age (OR 1.8) were more likely to require ICU admission. No patient above 10 months of age needed ICU monitoring. The use of respiratory support justifying ICU was known within the first 4 h after surgery for almost all (32/33, 97%) of these patients. 4/33 (12.1%) were kept intubated and the remaining needed non-invasive ventilation. Only one patient (1/122, 0.8%) was reintubated 12 h after surgery for progressive respiratory distress. CONCLUSION Approximately a quarter of patients required ICU-level care after supraglottoplasty. For nearly all patients without comorbidities requiring ICU, this can be safely predicted within the first 4 h after surgery. Our data suggest that selected patients undergoing supraglottoplasty may be safely monitored outside of an ICU setting after an observation period in the post-anesthesia care unit. LEVEL OF EVIDENCE 4 Laryngoscope, 134:466-470, 2024.
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Affiliation(s)
- Carolanne Gagnon
- Department of Pediatric Otolaryngology-Head and Neck Surgery, CHU Ste-Justine, Montreal, Quebec, Canada
| | - Simon Bérubé
- Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada
| | - Michaël Sauthier
- Department of Pediatrics, Pediatric Intensive Care Unit, CHU Ste-Justine, Montreal, Quebec, Canada
- CHU Sainte Justine Research Institute, CHU Sainte Justine, Montreal, Quebec, Canada
| | - Noémie Rouillard-Bazinet
- Department of Pediatric Otolaryngology-Head and Neck Surgery, CHU Ste-Justine, Montreal, Quebec, Canada
- CHU Sainte Justine Research Institute, CHU Sainte Justine, Montreal, Quebec, Canada
| | - Mathieu Bergeron
- Department of Pediatric Otolaryngology-Head and Neck Surgery, CHU Ste-Justine, Montreal, Quebec, Canada
- CHU Sainte Justine Research Institute, CHU Sainte Justine, Montreal, Quebec, Canada
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Bredun S, Kotowski M, Mezydlo J, Szydlowski J. Characteristics of Patients with Laryngomalacia: A Tertiary Referral Center Experience of 106 Cases. Diagnostics (Basel) 2023; 13:3180. [PMID: 37892001 PMCID: PMC10605856 DOI: 10.3390/diagnostics13203180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 09/10/2023] [Accepted: 10/05/2023] [Indexed: 10/29/2023] Open
Abstract
Laryngomalacia (LM) is the most common airway congenital anomaly and the main cause of stridor in infants. Some patients with severe airway symptoms or with feeding difficulties require surgical intervention. Synchronous airway lesions (SALs) may influence the severity and course of the disease. This study aimed to determine the prevalence of various types of LM and SALs and their influence on surgical intervention decisions and feeding difficulties. Moreover, the study focused on the interrelations between SALs and the type of LM or the presence of feeding difficulties. A retrospective analysis of 106 pediatric patients revealed a significant relationship between type 2 LM and the necessity of surgical treatment. We also found a significant effect of LM type 2 on feeding difficulty. Type 1 LM is significantly more characteristic in premature children. Among different comorbidities, SALs are suspected of modification of the course and severity of LM. This study did not find a significant effect of SALs on the incidence of supraglottoplasty or feeding difficulty.
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Affiliation(s)
| | - Michal Kotowski
- Department of Pediatric Otolaryngology, Poznan University of Medical Sciences, 27/33 Szpitalna Street, 60-572 Poznan, Poland
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Chen J, Xu H, Li X. Von Mises stress peak (VMSP) and laryngomalacia severity score (LSS) are extremely useful in the selection of treatment for laryngomalacia. Eur Arch Otorhinolaryngol 2023; 280:3287-3293. [PMID: 36757513 DOI: 10.1007/s00405-023-07866-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 01/29/2023] [Indexed: 02/10/2023]
Abstract
OBJECTIVE To analyze the judgment efficiency of a computer stress model and severity score in severity evaluation and treatment plan selection of laryngomalacia patients. METHODS Twenty-two children (12 cases in the operation group and 10 cases in the follow-up group) with moderate to severe laryngomalacia were assessed by laryngomalacia severity score (LSS) which included visual analogue scale (VAS) and clinical score. A computer stress model of the laryngeal cavity was constructed for all children, with the von Mises stress peak (VMSP) of the model used as another quantitative evaluation method. The ROC curves of two quantitative evaluation methods, the LSS and the VMSP, were analyzed respectively, according to the clinical guideline which is regarded as the gold standard for judging whether surgery is needed. The diagnostic efficiency indexes such as sensitivity, specificity, and accuracy were calculated. The area under ROC curves (AUC) of the two methods were compared by a DeLong model. Spearman correlation analysis and Kappa test were used to test the correlation and consistency of the two quantitative evaluation methods. The independent sample t test was used to compare the difference of LSS and VMSP between operation group and follow-up group. RESULTS The sensitivity, specificity, and accuracy of LSS in judging whether laryngomalacia was operated or not were 83.33%, 80.00% and 81.82%, respectively, and the area under ROC curve (AUC) was 0.825 (p < 0.05). The sensitivity, specificity, and accuracy of the computer stress model for laryngomalacia were 58.33%, 90.00% and 72.73%, respectively, and the AUC was 0.796 (p < 0.05). The spearman correlation coefficient between LSS and VMSP was 0.833, p < 0.001, which is statistically significant. LSS (t = 3.251, p = 0.004) and VMSP (t = 2.435, p = 0.024) of the two groups were statistically different. CONCLUSION VMSP and LSS have high diagnostic efficacy in the quantitative evaluation of the severity of laryngomalacia and the selection of treatment plan. The consistency of the two quantitative evaluation methods is good, which has practical value for the evaluation of the severity of laryngomalacia and has guiding significance for surgery.
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Affiliation(s)
- Jiali Chen
- Department of Otorhinolaryngology Head and Neck Surgery, Children's Hospital of Shanghai, Shanghai Jiao Tong University, 355th Luding Road, Shanghai, 200062, People's Republic of China
| | - Hongming Xu
- Department of Otorhinolaryngology Head and Neck Surgery, Children's Hospital of Shanghai, Shanghai Jiao Tong University, 355th Luding Road, Shanghai, 200062, People's Republic of China
| | - Xiaoyan Li
- Department of Otorhinolaryngology Head and Neck Surgery, Children's Hospital of Shanghai, Shanghai Jiao Tong University, 355th Luding Road, Shanghai, 200062, People's Republic of China.
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Kothari DS, Kanotra SP. Optimal laser usage improves surgical efficiency in pediatric supraglottoplasty. Int J Pediatr Otorhinolaryngol 2023; 164:111412. [PMID: 36543062 DOI: 10.1016/j.ijporl.2022.111412] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 11/08/2022] [Accepted: 12/08/2022] [Indexed: 12/13/2022]
Abstract
OBJECTIVES To compare patient specific and surgical efficiency outcomes in children undergoing supraglottoplasty (SGP) with flexible fiber CO2 laser in Ultrapulse mode versus cold steel at a tertiary care center. METHODS A single surgeon retrospective cohort study of pediatric patients with laryngomalacia undergoing SGP without concomitant or prior airway surgery. We reviewed perioperative complications, total hospital stay including intensive care admission, symptom resolution and the need for revision surgery. Surgical efficiency was measured as the mean total operative time and laryngeal suspension time. RESULTS Among 63 patients, 32 cold steel SGPs were compared with 31 flexible fiber CO2 Ultrapulse laser SGPs. There was no statistical difference in the demographic profile. There was no statistical difference in need for intraoperative resuscitation (1 [3.0%] vs 0 [0%] cases) or perioperative intubation (4 [12.1%] vs 2 [6.3%] cases), mean total days in ICU (1.09 [0.51] vs 1.06 [0.44] [p = 0.38]) or days hospitalized (1.73 [1.67] vs 1.62 [2.27] [p = 0.42]), symptom resolution, need for revision surgery (2 [6.3%] vs 0 [0%] [p = 0.49] patients) or mean operative time (29.0 [14.19] vs. 32.2 [22.71] [p = 0.95] minutes). There was a statistically significant decreased time in laryngeal suspension in the laser group versus cold steel group (5.9 [1.80] vs 7.9 [2.19] [p = 0.006] minutes). CONCLUSION For pediatric SGPs, optimal flexible fiber CO2 laser usage can improve surgical efficiency in comparison to cold steel, with no differences in postoperative outcomes or complications. Both the flexible fiber CO2 laser and cold steel SGPs are safe and effective methods for treatment of laryngomalacia.
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Affiliation(s)
- Dhruv Shreedhar Kothari
- University of Iowa Hospitals and Clinics, Department of Otolaryngology - Head & Neck Surgery, 200 Hawkins Drive, Iowa City, IA, 52242, USA.
| | - Sohit Paul Kanotra
- University of Iowa Hospitals and Clinics, Department of Otolaryngology - Head & Neck Surgery, 200 Hawkins Drive, Iowa City, IA, 52242, USA.
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Bhatta S, Gandhi S, Ganesuni D, Ghanpur AD. Long term Follow Up of Severe Laryngomalacia Patients Following CO 2 LASER Supraglottoplasty. Indian J Otolaryngol Head Neck Surg 2022; 74:2472-2476. [PMID: 36452855 PMCID: PMC9702166 DOI: 10.1007/s12070-020-02212-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Accepted: 10/06/2020] [Indexed: 11/29/2022] Open
Abstract
Laryngomalacia is the most common cause of stridor. It is believed to be due to delayed development of the supraglottic structures. On the basis of presentation, it has been divided into 3 grades. Management is dependent upon the grades: Mild and moderate laryngomalacia are managed conservatively, while CO2 LASER supraglottoplasty is the surgical management of choice for severe disease. In this study we evaluated the outcomes of supraglottopasty in long term follow up. It was a retrospective study which included patients with severe laryngomalacia who have undergone supraglottoplasty for the dates from July 2013 to July 2018. Weight and height of the patients were taken during the follow up visit after one year and have been compared with that of the normal children of comparable age using the pediatrics growth charts. Follow up was done by telephonic conversation to evaluate the status of other symptoms associated with laryngomalacia. Total of 44 patients were included in the study, 47.7% and 52.3% females and males respectively. Weight for age, weight for height and height for age were normal in 80.9%, 80.9% and 76.1% of patients respectively after supraglottoplasty. Of the patients studied, stridor was resolved in 80.9%, early tiredness during play was resolved in 43.2%, swallowing was normal in 85.7% and there was no aspiration in 90.5%. It can be concluded that patients with severe laryngomalacia improved with respect to airway symptoms, as well as, weight and height on long term follow up after CO2 LASER supraglottoplasty. It is important to evaluate the general status of the patients as a whole to truly assess the success of the surgery in addition to the airway symptoms.
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Affiliation(s)
- Subash Bhatta
- Department of Laryngology, Deenanath Mangeshkar Hospital and Research Centre, Erandwane, Pune, 411004 India
| | - Sachin Gandhi
- Department of Laryngology, Deenanath Mangeshkar Hospital and Research Centre, Erandwane, Pune, 411004 India
| | - Dushyanth Ganesuni
- Department of Laryngology, Deenanath Mangeshkar Hospital and Research Centre, Erandwane, Pune, 411004 India
| | - Asheesh Dora Ghanpur
- Department of Laryngology, Deenanath Mangeshkar Hospital and Research Centre, Erandwane, Pune, 411004 India
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Glibbery N, Roplekar Bance R, Jonas N, Bewick J. Synchronous airway lesions in children with severe, progressive and atypical laryngomalacia - Experience of a UK tertiary referral centre. Int J Pediatr Otorhinolaryngol 2022; 152:110984. [PMID: 34838327 DOI: 10.1016/j.ijporl.2021.110984] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2021] [Revised: 09/25/2021] [Accepted: 11/10/2021] [Indexed: 12/01/2022]
Abstract
OBJECTIVES Laryngomalacia is the commonest cause of stridor in the paediatric population. Whilst usually self-limiting, studies have suggested that the presence of synchronous airway lesions (SALs) might be associated with more severe clinical presentation and additional morbidity. However, evidence in the literature is scarce, contributing to controversy regarding the appropriate investigation and management of children with laryngomalacia. The aim of this study was to explore the prevalence, clinical significance and risk factors of SALs in children with severe, progressive and atypical laryngomalacia symptoms. METHODS Retrospective analysis of the records of all paediatric patients diagnosed with laryngomalacia in a UK tertiary referral centre, over a 2-year period, was undertaken. Data on demographics, comorbidities, management and presence of SALs were collected. RESULTS The study included 130 patients with laryngomalacia. Seventy-eight patients required investigation with microlaryngobronchoscopy (MLB), based on clinical presentation. SALs were identified in 22 patients (28.2%), 6 of which (7.7%) required surgical intervention. The commonest airway lesions included tracheomalacia, bronchomalacia and subglottic stenosis. A correlation between the presence of neurodevelopmental conditions in children and SALs was noted (p value < 0.05). The presence of SALs was not associated with sex, gestational age at birth or other medical comorbidities. CONCLUSION The results of this study allow professionals to counsel families about the utility of MLB in children with severe, progressive and atypical laryngomalacia symptoms and inform management pathways for clinicians not working in airway centres. We support the clinical practice that progressive, atypical or severe laryngomalacia symptoms should prompt consideration of an MLB, to identify potential synchronous airway lesions. Furthermore, we propose that a higher index of suspicion and more thorough investigation might be indicated in children with neurodevelopmental disorders.
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Affiliation(s)
- Natalia Glibbery
- Department of Paediatric Otolaryngology, Addenbrookes Hospital, Hills Road, Cambridge, CB20QQ, UK.
| | - Rujuta Roplekar Bance
- Department of Paediatric Otolaryngology, Addenbrookes Hospital, Hills Road, Cambridge, CB20QQ, UK
| | - Nicolaas Jonas
- Department of Paediatric Otolaryngology, Addenbrookes Hospital, Hills Road, Cambridge, CB20QQ, UK
| | - Jessica Bewick
- Department of Paediatric Otolaryngology, Addenbrookes Hospital, Hills Road, Cambridge, CB20QQ, UK
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Xu H, Chen J, Pu S, Li X. Three-dimensional finite element modeling for evaluation of laryngomalacia severity in infants and children. J Int Med Res 2021; 48:300060520926407. [PMID: 32493145 PMCID: PMC7273773 DOI: 10.1177/0300060520926407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
This study was performed to investigate the feasibility of using a three-dimensional (3D) finite element model for laryngomalacia severity assessment. We analyzed laryngeal computed tomography images of seven children with laryngomalacia using Mimics software. The gray threshold of different tissues was distinguishable, and a 3D visualization model and finite element model were constructed. The laryngeal structure parameters were defined. The peak von Mises stress (PVMS) value was obtained through laryngeal mechanical analysis. The PVMS values of the laryngeal soft tissue and cartilage scaffolds were independently correlated with disease severity. After stress loading the model, the relationship between laryngomalacia severity and the PVMS value was apparent. However, the PVMS value of laryngeal soft tissue was not correlated with laryngomalacia severity. This study established the efficacy of a finite element model to illustrate the morphological features of the laryngeal cavity in infants with laryngomalacia. However, further study is required before widespread application of 3D finite element modeling of laryngomalacia. PVMS values of the laryngeal cartilage scaffold might be useful for assessment of laryngomalacia severity. These findings support the notion that structural abnormalities of the laryngeal cartilage may manifest as quantifiable changes in stress variants of the supraglottic larynx.
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Affiliation(s)
- Hongming Xu
- Department of Otolaryngology- Head and Neck Surgery, Children's Hospital of Shanghai, Shanghai Jiao Tong University, Shanghai, People's Republic of China
| | - Jiali Chen
- Department of Otolaryngology- Head and Neck Surgery, Children's Hospital of Shanghai, Shanghai Jiao Tong University, Shanghai, People's Republic of China
| | - Shilei Pu
- Department of Otolaryngology- Head and Neck Surgery, Children's Hospital of Shanghai, Shanghai Jiao Tong University, Shanghai, People's Republic of China
| | - Xiaoyan Li
- Department of Otolaryngology- Head and Neck Surgery, Children's Hospital of Shanghai, Shanghai Jiao Tong University, Shanghai, People's Republic of China
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Alshumrani RA, Matt BH, Daftary AS, Peterson-Carmichael SL, Slaven JE, Cristea AI. Correlation between the clinical severity of laryngomalacia and endoscopic findings. Saudi Med J 2021; 41:406-412. [PMID: 32291428 PMCID: PMC7841616 DOI: 10.15537/smj.2020.4.25014] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Objectives: To correlate the clinical severity of laryngomalacia (LM) with endoscopic findings, swallowing evaluations and polysomnography in a cohort of patients . Methods: We conducted a retrospective analysis between 2017-2018 on a cohort of patients diagnosed with upper airway obstruction (UAO), stridor, noisy breathing or laryngomalacia. This study took place at the Pediatric Pulmonology Department, Riley Children’s Hospital, Indianapolis, United States of America. Results: There were 157 patients with laryngomalacia included in the study. Patients with severe LM were significantly younger than those with mild LM (p=0.0214) and moderate LM (p=0.0220). Subjects with type I of LM were significantly older than type III (p=0.0051).When associations were tested between polysomnogram (PSG) variables and clinical severity, there were significant associations with age at PSG. The overall apnea-hypopnea index (AHI) in mild (p=0.0103) and moderate (p=0.0242) were significantly lower than the severe group. The rapid eye movement (REM) AHI was significantly lower in moderate cases than severe (p=0.0134). The end-tidal carbon dioxide (EtCO2) peak was significantly lower in mild cases than severe (p=0.0141).The total sleep time (TST) peripheral capillary oxygen saturation (SpO2) 90% occurs in both mild (p=0.0197) and moderate (p=0.0498)) were significantly lower than the severe group. Conclusions: The severity of the clinical manifestations of LM did not correlate with the different endoscopic types in our study. The presence of cyanosis was associated with type III LM. Rapid eye movement AHI and EtCO2 in polysomnogram were remained significantly associated with clinical severity.
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Affiliation(s)
- Ranya A Alshumrani
- Department of Pediatrics, King Abdulaziz University, Jeddah, Kingdom of Saudi Arabia. E-mail.
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AbdelFattah ElSobki A, Hashish MI, El-Kholy NA. One and half coblation supraglottoplasty: A novel technique for management of type II laryngomalacia. Int J Pediatr Otorhinolaryngol 2020; 138:110330. [PMID: 32889439 DOI: 10.1016/j.ijporl.2020.110330] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2020] [Revised: 08/22/2020] [Accepted: 08/22/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Endoscopic supraglottoplasty is the mainstay surgical procedure in treatment of laryngomalacia. Various instruments have been used with coblation recently gaining widespread attention. Regarding the technique used, cutting the aryepiglottic folds is associated with rapid improvement but carries risk of restenosis while outer scar contracture method has delayed but established result. Therefore, this study was conducted to introduce a modified coblation supraglottoplasty technique gathering both benefits and evaluate its results and effectiveness. METHODS Retrospective study included patients diagnosed with type II laryngomalacia was conducted. Supraglottoplasty was done by "one and half coblation supraglottoplasty" technique which involves cutting of one aryepiglottic fold while the other one is laterally coagulated. Patients' basic and clinical data were assessed. Outcome measures included assessment of inspiratory stridor, failure to thrive, choking, cyanosis, lowest oxygen saturation levels and weight gain. RESULTS Seventeen patients were included in this study with a mean age of 3.71 ± 1.1 months. Significant statistical improvement was reached regarding stridor, failure to thrive and cyanosis. Also, minimal oxygen saturation and weight gain were significantly improved. None of the cases needed tracheostomy and no major postoperative complications occurred. CONCLUSION We conclude that "one and half coblation supraglottoplasty" is an effective and safe treatment for type II laryngomalacia with satisfactory outcomes. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Ahmed AbdelFattah ElSobki
- Department of Otorhinolaryngology-Head & Neck Surgery, Faculty of Medicine, Mansoura University, Egypt
| | | | - Noha Ahmed El-Kholy
- Department of Otorhinolaryngology-Head & Neck Surgery, Faculty of Medicine, Mansoura University, Egypt.
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Xu H, Chen F, Zheng Y, Li X. Efficacy and toxicities of low-temperature plasma radiofrequency ablation for the treatment of laryngomalacia in neonates and infants: a prospective randomized controlled trial. ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:1366. [PMID: 33313111 PMCID: PMC7723570 DOI: 10.21037/atm-20-3164] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
Abstract
Background Laryngomalacia is the most common cause of stridor in neonates and infants, and supraglottoplasty is the mainstay of surgical treatment. Although low-temperature plasma radiofrequency ablation (LTP-RFA) using coblation technology has been used for treating laryngomalacia, it is still lack of high-quality clinical evidence. Therefore, we conduct this prospective randomized study to clearly define the role of LTP-RFA for the treatment of laryngomalacia in neonates and infants. Methods Between Jan 2017 and Dec 2019, a total of 89 children with laryngomalacia were included for analysis. All patients were initially stratified according to the severity of laryngomalacia. Patients with severe laryngomalacia were randomly assigned to receive LTP-RFA or traditionally surgical supraglottoplasty, while patients with moderate laryngomalacia were assigned to LTP-RFA or observation. The primary end point was the efficacy and toxicities of LTP-RFA by assessing the changes of clinical score and visual analogue scale (VAS) symptom score. The total score was the combination of clinical score with VAS score. Results Of the 89 children, 40 children presented with severe laryngomalacia, and the remaining 49 children were diagnosed as moderate laryngomalacia. The median age was 68 days (range, 19 to 337 days). For children with severe laryngomalacia, our results showed that LTP-RFA treatment significantly reduced the operative time (5.55±1.66 vs. 18.7±5.31 min, P<0.001), length of hospital stay (6.71±1.15 vs. 7.95±1.55 days, P=0.008) and the amount of intraoperative hemorrhage (1.71±1.79 vs. 4.90±1.82, P<0.001) when compared to traditionally surgical supraglottoplasty, while the treatment efficacy was comparable between LTP-RFA and traditionally surgical supraglottoplasty in terms of changed total score (P=0.322), changed clinical score (P=0.135) and changed VAS symptom score (P=0.559). Additionally, for children with moderate laryngomalacia, LTP-RFA treatment significantly improved the symptom evaluated by total score (P<0.001), clinical score (P<0.001) and VAS symptom score (P<0.001) in comparison with the observation group. Post-operative pneumonia was observed in 10 patients. No surgical related death was reported. Conclusions The present study indicated that LTP-RFA was an effective treatment option for both severe and moderate laryngomalacia in neonates and infants with a low intraoperative complication. Long-term outcomes of LTP-RFA for laryngomalacia would be reported in further studies.
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Affiliation(s)
- Hongming Xu
- Department of Otolaryngology-Head and Neck Surgery, Children's Hospital of Shanghai, Shanghai Jiao Tong University, Shanghai, China
| | - Fang Chen
- Department of Otolaryngology-Head and Neck Surgery, Children's Hospital of Shanghai, Shanghai Jiao Tong University, Shanghai, China
| | - Yangyang Zheng
- Department of Otolaryngology-Head and Neck Surgery, Children's Hospital of Shanghai, Shanghai Jiao Tong University, Shanghai, China
| | - Xiaoyan Li
- Department of Otolaryngology-Head and Neck Surgery, Children's Hospital of Shanghai, Shanghai Jiao Tong University, Shanghai, China
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Patel VA, Adkins D, Ramadan J, Williamson A, Carr MM. Surgical Intervention for Laryngomalacia: Age-Related Differences in Postoperative Sequelae. Ann Otol Rhinol Laryngol 2020; 129:901-909. [PMID: 32468827 DOI: 10.1177/0003489420922862] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Identify risk factors and determine perioperative morbidity of children undergoing surgery for laryngomalacia (LM). METHODS A retrospective analysis of the multi-institutional American College of Surgeons National Surgical Quality Improvement Program-Pediatric Database (ACS-NSQIP-P) was performed to abstract patients aged <18 years with LM (ICD-10 code Q31.5) who underwent laryngeal surgery (CPT code 31541) from 2015 to 2017. Analyzed clinical variables include patient demographics, hospital setting, length of stay, medical comorbidities, postoperative complications, readmission, and reoperation. RESULTS A total of 491 patients were identified, 283 were male (57.6%) and 208 were female (42.4%). The mean age at time of surgery was 1.07 years (range .01-17 years). Younger patients were more likely to undergo surgery in the inpatient setting compared to their counterparts (P < .001). Infants were more likely to have prolonged duration of days from admission to surgery (P < .001), days from surgery to discharge (P < .001), and total length of stay (P<.0010). Finally, there was no significant difference between age groups with respect to 30-day general surgical complications (P = .189), with an overall low incidence of reintubation (1.2%), readmission (3.1%), and reoperation (1.6%). CONCLUSION This analysis supports laryngeal surgery as a safe surgical procedure for LM. However, younger children are more likely to undergo operative intervention in the inpatient setting, endure delays from hospital admission to surgical intervention, and experience a prolonged length of stay due to their overall medical complexity. Recognition of key factors may assist in optimizing perioperative risk assessment and promote timely procedural planning in this unique pediatric patient subpopulation.
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Affiliation(s)
- Vijay A Patel
- Department of Otolaryngology-Head and Neck Surgery, The Pennsylvania State University, College of Medicine, Hershey, PA, USA
| | - David Adkins
- West Virginia University School of Medicine, Morgantown, WV, USA
| | - Jad Ramadan
- West Virginia University Rockefeller Neuroscience Institute, Morgantown, WV, USA
| | - Adrian Williamson
- Department of Otolaryngology-Head and Neck Surgery, West Virginia University School of Medicine, Morgantown, WV, USA
| | - Michele M Carr
- Department of Otolaryngology, University at Buffalo, Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY, USA
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Sivarajah S, Isaac A, Anderson S, Mehta D, Hong P, Alrajhi Y, El-Hakim H. Validity of laryngomalacia classification systems: A multi-institutional agreement study. Clin Otolaryngol 2020; 45:471-476. [PMID: 32198979 DOI: 10.1111/coa.13530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Revised: 02/18/2020] [Accepted: 03/08/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To determine the agreement of paediatric otolaryngologists on classifying laryngomalacia (LM). DESIGN Intra- and interobserver agreement study of two classification systems. SETTING Three tertiary referral paediatric centres. PARTICIPANTS Three paediatric otolaryngologists, who were blinded to any clinical details, interpreted the videos of children diagnosed with LM using the Holinger and Olney classifications independently. They rated the videos twice with a washout period of at least 2 weeks. THE MAIN OUTCOME MEASURES Inter- and intra-observer agreement measured by overall Fleiss kappa and unweighted Cohen's kappa coefficients. The secondary outcome measures were inter- and intra-observer agreement on the individual anatomical subunits of the supraglottis affected by LM, characterised by the subcategories of the classifications. RESULTS Video records of infants and children <18 years who had an endoscopic diagnosis of LM from 2012 to 2017 were retrospectively chosen for inclusion (n = 73). The overall Fleiss kappa coefficient was 0.25 (95% CI 0.18-0.32) amongst the raters using the Holinger classification and 0.31 (95% CI 0.21-0.42) for the Olney classification. Intra-observer agreement using the Holinger classification was 0.30 (95% CI 0.18-0.42), 0.62 (95% CI 0.23-0.85) and 0.84 (95% CI 0.75-0.94], whilst the Olney classification yielded values of 0.41 (95% CI 0.26-0.56), 0.51 (95% CI 0.29-0.63) and 0.63 (95% CI 0.48-0.78). CONCLUSIONS The agreement on types of LM between expert observers is modest using the Holinger and Olney classifications. This has significant implications for accurately diagnosing LM and exposes potential obstacles against credible pooling of data and extrapolation of information.
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Affiliation(s)
- Shanmugappiriya Sivarajah
- Division of Otolaryngology Head & Neck Surgery, Division of Pediatric Surgery, Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
| | - Andre Isaac
- Division of Otolaryngology Head & Neck Surgery, Division of Pediatric Surgery, Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
| | - Shelaina Anderson
- Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Deepak Mehta
- Bobby R. Alford Department of Otolaryngology Head and Neck Surgery, Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA
| | - Paul Hong
- Pediatric Otolaryngology, Division of Otolaryngology-Head & Neck Surgery, Department of Surgery, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Yaser Alrajhi
- Division of Otolaryngology Head & Neck Surgery, Division of Pediatric Surgery, Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
| | - Hamdy El-Hakim
- Division of Otolaryngology Head & Neck Surgery, Division of Pediatric Surgery, Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
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Coagulation of the lateral surface of aryepiglottic folds as an alternative to aryepiglottic fold release in management of type 2 laryngomalacia. Auris Nasus Larynx 2019; 47:443-449. [PMID: 31677853 DOI: 10.1016/j.anl.2019.10.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2019] [Revised: 10/08/2019] [Accepted: 10/15/2019] [Indexed: 11/20/2022]
Abstract
OBJECTIVE Endoscopic supraglottoplasty is the procedure of choice in treatment of laryngomalacia with CO2 laser and cold steel being the most common instruments used with excellent results. However, bleeding, supraglottic stenosis and aspiration may occur leading to serious complications. Using coblation in management of laryngomalacia was found to be beneficial. Therefore, we conducted this study to evaluate the outcome of supraglottoplasty done by coagulation using coblation of the lateral surface of aryepiglottic folds as an alternative technique to aryepiglottic fold release in management of type 2 laryngomalacia. METHODS Retrospective study was conducted at Mansoura University Hospitals; Egypt from November 2017 to March 2018 included patients diagnosed with severe type 2 laryngomalacia. Supraglottoplasty was done by using coblator applied to the lateral surface of aryepiglottic folds allowing for lateral scarring thus widening the airway, preventing supraglottic collapse and avoiding re-stenosis. Outcome measures included assessment of presence or absence of the following symptoms preoperatively and postoperatively: inspiratory stridor, failure to thrive, choking and cyanosis. Preoperative and postoperative lowest oxygen saturation levels, weight-by-age percentile, and need for tracheostomy were assessed. RESULTS Nine patients were included in this study with a mean age of 3.78 ± 1.20 months (range 2-6 months). Overall success rate was 89%. The most significantly improved symptom was stridor (p-value 0.008). Significant improvement in lowest oxygen saturation levels (from 89.11 ± 3.06% pre-operatively to 96.44 ± 3.50% post-operatively) and weight gain (from 4288.9 ± 643.1 gm. preoperatively to 5505.55 ± 1017.4 gm. 1 month postoperatively) was achieved. No detected re-stenosis on follow up and none of our cases needed tracheostomy. CONCLUSION Supraglottoplasty by coagulation of the lateral surface of aryepiglottic folds using coblation is an effective and safe technique and can improve airway symptoms and weight gain in patients with type 2 laryngomalacia.
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Chen DW, Carol Liu YC. Routine admission to step-down unit as an alternative to intensive care unit after pediatric supraglottoplasty. Int J Pediatr Otorhinolaryngol 2019; 116:181-185. [PMID: 30554695 DOI: 10.1016/j.ijporl.2018.11.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Revised: 11/01/2018] [Accepted: 11/01/2018] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To evaluate the feasibility and the outcomes for step-down (SD) unit admission as an alternative to intensive care unit (ICU) admission after supraglottoplasty in the pediatric patient. METHODS A review of 98 patients who underwent supraglottoplasty from 2012 to 2017 at a tertiary referral pediatric hospital was performed. An SD unit had 1-to-3 nurse-to-patient ratio with noninvasive positive pressure ventilation capability. Data variables included demographics, comorbidities, preoperative and postoperative respiratory requirements, and length of stay. RESULTS Routine admission to SD occurred for 85% patients while 15% patients were selectively admitted to ICU due to intubation requirement or perioperative respiratory distress. In SD, noninvasive respiratory support was required for 28 (34%) patients. Three (4%) required re-intubation and ICU transfer without delay in care. Patients at high risk for requiring respiratory support after surgery have a neurologic condition (OR 7.0, 95% 2.4-20.2, p < 0.01) or intrinsic pulmonary disease (OR 4.5, 95% CI 1.5-13.3, p < 0.01). Median length of stay was shorter for patients in step-down (1 day, IQR 1-2). CONCLUSION Patients can be managed safely in a SD unit after supraglottoplasty supporting de-escalation of care. Patients with neurologic and pulmonary comorbidities may have higher respiratory needs postoperatively. Prospective studies are warranted to further optimize resource allocation.
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Affiliation(s)
- Diane W Chen
- Dept. Otolaryngology - Head & Neck Surgery, Baylor College of Medicine, Houston, TX, USA
| | - Yi-Chun Carol Liu
- Dept. Otolaryngology - Head & Neck Surgery, Baylor College of Medicine, Houston, TX, USA; Texas Children's Hospital, Houston, TX, USA.
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Ribeiro J, Júlio S, Dias C, Santos M, Spratley J. Supraglottoplasty in children with laryngomalacia: A review and parents' appraisal. Am J Otolaryngol 2018; 39:613-617. [PMID: 29807660 DOI: 10.1016/j.amjoto.2018.05.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2018] [Revised: 05/10/2018] [Accepted: 05/17/2018] [Indexed: 11/20/2022]
Abstract
PURPOSE To assess the parents' perspective concerning the children's clinical picture before and after supraglottoplasty for the treatment of laryngomalacia (LM). MATERIALS AND METHODS Retrospective study in 110 children diagnosed with LM followed at the Pediatric Otorhinolaryngology outpatient clinics of S. João Hospital Center, between 2008 and 2016. Children who underwent supraglottoplasty were reviewed in terms of demographics, symptoms, comorbidities, treatment and follow-up. Parents were interviewed and filled out a structured questionnaire designed to evaluate their perception of the child's clinical picture and their degree of comfort before and after surgery. RESULTS Thirty-one children (28,2%) underwent supraglottoplasty at a median age of 6 months-old. Twelve patients had one or more medical comorbidities. Stridor was present in all children on the pre-operative period and resolved in 92,3% of the cases after supraglottoplasty; shortness of breath persisted in 3,8% in contrast to the previous 57,7%; and feeding difficulties remained in 15,4% children against the 65,4% before the procedure. Failure in thriving was also a pre-operative complaint, that recovered as reported by parents in all children after supraglottoplasty. No surgical complications were reported, and the median hospital stay was two days. In a 0 to 10 points scale, the median level of the parents' comfort with their child's clinical picture before supraglottoplasty was one point which was significantly worse than the mean level of ten points after surgery (p < 0.001). CONCLUSIONS In severe cases, LM can have a strong negative impact on family dynamics and functioning. In selected cases, supraglottoplasty can be a safe and effective treatment option which is associated with a high degree of parental satisfaction.
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Affiliation(s)
- Joana Ribeiro
- Department of Surgery and Physiology/Otorhinolaryngology, University of Porto Faculty of Medicine, Portugal, Alameda Professor Hernâni Monteiro, 4200-319 Porto, Portugal.
| | - Sara Júlio
- Department of Surgery and Physiology/Otorhinolaryngology, University of Porto Faculty of Medicine, Portugal, Alameda Professor Hernâni Monteiro, 4200-319 Porto, Portugal; Department of Otorhinolaryngology, S. João Hospital Center, EPE, Porto, Portugal, Alameda Professor Hernâni Monteiro, 4200-319 Porto, Portugal
| | - Cláudia Dias
- Department of Community Medicine, Information and Decision in Health, University of Porto Faculty of Medicine, Portugal, Alameda Professor Hernâni Monteiro, 4200-319 Porto, Portugal; CINTESIS - Centre for Health Technology and Services Research, Porto, Portugal, Alameda Professor Hernâni Monteiro, 4200-319 Porto, Portugal
| | - Margarida Santos
- Department of Otorhinolaryngology, S. João Hospital Center, EPE, Porto, Portugal, Alameda Professor Hernâni Monteiro, 4200-319 Porto, Portugal
| | - Jorge Spratley
- Department of Surgery and Physiology/Otorhinolaryngology, University of Porto Faculty of Medicine, Portugal, Alameda Professor Hernâni Monteiro, 4200-319 Porto, Portugal; Department of Otorhinolaryngology, S. João Hospital Center, EPE, Porto, Portugal, Alameda Professor Hernâni Monteiro, 4200-319 Porto, Portugal; CINTESIS - Centre for Health Technology and Services Research, Porto, Portugal, Alameda Professor Hernâni Monteiro, 4200-319 Porto, Portugal
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Vandjelovic ND, Brown JR, Traboulsi HT, Thottam PJ. Impact of Infant Supraglottoplasty on Quality of Life. Otolaryngol Head Neck Surg 2018; 159:564-571. [PMID: 29759025 DOI: 10.1177/0194599818775091] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objectives The objective of the present study is to examine the impact of supraglottoplasty on the quality of life (QOL) of caregivers and infants with severe laryngomalacia and moderate laryngomalacia with feeding difficulties. Study Design Prospective cohort study. Setting Tertiary children's hospital. Subjects and Methods Thirty-nine infants who underwent supraglottoplasty were examined. The primary caregiver answered the 47-item short form of the Infant and Toddler Quality of Life Questionnaire-47 pre- and postoperatively; the subsection scores were compared. A 1-way analysis of variance was performed to analyze the effect of age and sex. A comparison was made between our cohort and a general population of healthy children. Results The average age at surgery was 4.0 months, and 53% of the patients were male. There was significant postoperative improvement in overall health, physical ability, growth and development, bodily pain, temperament, emotional impact on the caregiver, impact on caregiver's time, and family cohesion scores ( P < .05). The same subscale scores remained significantly improved postoperatively after age and sex were controlled. Preoperative QOL scores were significantly worse than those of the general population in nearly all categories. Postoperative physical ability ( P = .009) and temperament ( P = .011) QOL scores were higher than the those of the general population. Scores for growth and development ( P = .132), bodily pain ( P = .481), and family cohesion ( P = .717) were equivalent to those of the general population. Conclusion QOL was significantly improved after supraglottoplasty for infants with severe laryngomalacia and moderate laryngomalacia with feeding difficulties. After supraglottoplasty, QOL was similar to that of the general infant population in most categories.
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Affiliation(s)
- Nathan D Vandjelovic
- 1 Department of Otolaryngology-Head and Neck Surgery, Detroit Medical Center, Detroit, Michigan, USA
| | - Jason R Brown
- 1 Department of Otolaryngology-Head and Neck Surgery, Detroit Medical Center, Detroit, Michigan, USA
| | - Henri T Traboulsi
- 2 Department of Pediatric Otolaryngology, Texas Children's Hospital, Houston, Texas, USA
| | - Prasad John Thottam
- 3 Department of Pediatric Otolaryngology, Michigan Pediatric Ear, Nose and Throat Associates, West Bloomfield, Michigan, USA.,4 Department of Pediatric Otolaryngology-Head and Neck Surgery, Beaumont Children's Hospital, Royal Oak, Michigan, USA
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Sedaghat S, Fredes F, Tapia M. Supraglottoplasty for laryngomalacia: The experience from Concepcion, Chile. Int J Pediatr Otorhinolaryngol 2017; 103:113-116. [PMID: 29224749 DOI: 10.1016/j.ijporl.2017.10.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Revised: 09/28/2017] [Accepted: 10/04/2017] [Indexed: 10/18/2022]
Abstract
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.
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Affiliation(s)
- Sahba Sedaghat
- Otolaryngologist at University of Concepcion and Hospital Guillermo Grant Benavente, Concepcion, Chile.
| | - Felipe Fredes
- Otolaryngologist at University of Concepcion and Hospital Guillermo Grant Benavente, Concepcion, Chile
| | - Mario Tapia
- Otolaryngologist at University of Concepcion and Hospital Guillermo Grant Benavente, Concepcion, Chile
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Abstract
AbstractBackground: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.
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Rajendran T, Ramalinggam G, Kamaru Ambu V. Rare presentation of bilobed posterior tongue in Goldenhar syndrome. BMJ Case Rep 2017; 2017:bcr-2017-219726. [PMID: 28765181 DOI: 10.1136/bcr-2017-219726] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
A bilobed posterior tongue is a rare malformation with few reported cases in the literature. This anomaly has not been demonstrated in patients with Goldenhar syndrome. We report a case of a 5-month-old child with the classic signs of Goldenhar syndrome and laryngomalacia with an incidental finding of a bilobed posterior tongue. Careful assessment and monitoring are crucial, especially in syndromic babies.
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Affiliation(s)
- Thilaga Rajendran
- Otorhinolaryngology, Hospital Tuanku Ja'afar, Seremban, Negeri Sembilan, Malaysia
| | - Ganesh Ramalinggam
- Otorhinolaryngology, Hospital Tuanku Ja'afar, Seremban, Negeri Sembilan, Malaysia
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Rathi A, Rathi S. Relative imbalance as etiology of laryngomalacia – A new theory. Med Hypotheses 2017; 98:38-41. [DOI: 10.1016/j.mehy.2016.11.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2016] [Revised: 10/06/2016] [Accepted: 11/08/2016] [Indexed: 10/20/2022]
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