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Huang YC, Cheng YL, Su WL, Lan CC, Wu YK, Yang MC. Co-existing obstructive sleep apnea reduces Nuss surgery efficacy in pectus excavatum. PLoS One 2022; 17:e0277494. [PMID: 36367884 PMCID: PMC9651565 DOI: 10.1371/journal.pone.0277494] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Accepted: 10/28/2022] [Indexed: 11/13/2022] Open
Abstract
Nuss surgery is effective in correcting pectus excavatum (PE), with a recurrence rate of 1.2–27%. Re-do surgery is successful but still has a 6% failure rate. Patients with obstructive sleep apnea (OSA) experience repetitive PE-associated sternal depression during sleep. As the prevalence of OSA among PE patients is higher than the average, co-existing OSA in PE patients might negatively affect the efficacy of Nuss surgery. This study aimed to evaluate the impact of co-existing OSA on Nuss surgery in patients with PE. In total, 20 adult patients with PE only and 9 patients with PE and OSA were analyzed. Polysomnography was performed before Nuss surgery to evaluate OSA. Sternovertebral distance (SVD) and radiographic Haller index (RHI) were recorded before surgery and at 3, 6, and 24 months postoperatively. The results showed that percentage changes in SVD in patients with PE only at 3, 6, and 24 months postoperatively were significantly increased compared with those in the patients with PE and OSA (31.1% vs. 14.1% at 3 months; 37.5% vs. 21.4% at 6 months; 42.5% vs. 19.2% at 24 months). Meanwhile, percentage changes in RHI were significantly lower in patients with PE alone than in the patients with PE and OSA (-22.9% vs. -9.3% at 3 months; -27.9% vs. -18.7% at 6 months; -30.6% vs. -16.7% at 24 months). This study showed that co-existing OSA might reduce the efficacy of Nuss surgery for patients with PE. We recommend that patients with PE should be evaluated and treated for OSA before surgery to prevent surgical failure after bar removal.
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Affiliation(s)
- Yi-Chih Huang
- Division of Pulmonary Medicine, Department of Internal Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei, Taiwan
- School of Medicine, Tzu Chi University, Hualien, Taiwan
| | - Yeung-Leung Cheng
- School of Medicine, Tzu Chi University, Hualien, Taiwan
- Division of Chest Surgery, Department of Surgery, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei, Taiwan
| | - Wen-Lin Su
- Division of Pulmonary Medicine, Department of Internal Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei, Taiwan
- School of Medicine, Tzu Chi University, Hualien, Taiwan
| | - Chou-Chin Lan
- Division of Pulmonary Medicine, Department of Internal Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei, Taiwan
- School of Medicine, Tzu Chi University, Hualien, Taiwan
| | - Yao-Kuang Wu
- Division of Pulmonary Medicine, Department of Internal Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei, Taiwan
- School of Medicine, Tzu Chi University, Hualien, Taiwan
| | - Mei-Chen Yang
- Division of Pulmonary Medicine, Department of Internal Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei, Taiwan
- School of Medicine, Tzu Chi University, Hualien, Taiwan
- * E-mail:
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Tonsil surgery in children under two years of age. The Journal of Laryngology & Otology 2021; 135:1019-1024. [PMID: 34526169 DOI: 10.1017/s0022215121002437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND More young children are undergoing tonsillectomy, driven by sleep-disordered breathing concerns. Their specific risks are not well described. METHOD A retrospective review was conducted of children aged 1-23 months undergoing tonsillectomy at one institution between 2014 and 2018. RESULTS A total of 157 children were identified (3.9 per cent of all tonsillectomies in those aged 0-16 years). Sixty-seven per cent were male. The youngest child was six months old; the smallest weighed 6.9 kg. Sixty-eight (43.3 per cent) had co-morbidities. The indication for tonsillectomy was sleep-disordered breathing in 94 per cent; 29.9 per cent had co-existing airway lesions, mostly laryngomalacia and tracheobronchomalacia. Of the children, 83.4 per cent were managed post-operatively on the surgical ward, and 63.7 per cent stayed 1 night. Emergency paediatric intensive care unit admission occurred in 3.8 per cent. Early respiratory complications and emergency paediatric intensive care unit admission were more common if the patient was medically complex, aged less than 18 months or weighed less than 12 kg. Re-operation for bleeding occurred in 1.9 per cent. CONCLUSION Most children stay 1 night on a general ward, with an uneventful course. Complications are occasionally severe, mostly in the very young and medically complex.
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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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Cheng YL, Tzeng IS, Yang MC. Increased prevalence of obstructive sleep apnea in patients with pectus excavatum: A pilot study. Tzu Chi Med J 2018; 30:233-237. [PMID: 30305787 PMCID: PMC6172901 DOI: 10.4103/tcmj.tcmj_115_17] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Revised: 12/12/2017] [Accepted: 01/08/2018] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE Laryngomalacia is the most common congenital laryngeal anomaly and is associated with pectus excavatum (PE). Patients with laryngomalacia and patients with obstructive sleep apnea (OSA) both experience upper airway obstruction, and patients with laryngomalacia had been found to have a higher prevalence of PE. However, no studies have established the prevalence of OSA in patients with PE. We conducted this pilot study to evaluate the prevalence of OSA in patients with PE. MATERIALS AND METHODS A total of 42 patients ≥20 years old with PE who were admitted for Nuss surgery to correct PE in Taipei Tzu Chi Hospital between October 2015 and September 2016 were invited to participate in the study; 31 of the 42 patients agreed. All 31 patients completed an Epworth sleepiness scale questionnaire to evaluate excessive daytime sleepiness (EDS) and underwent overnight polysomnography to evaluate OSA before Nuss surgery. RESULTS The prevalence of snoring in the study participants was 100%. Ten of 31 patients (32.3%) reported EDS. The overall prevalence of OSA with an apnea/hypopnea index ≥5/h was 25.8%, and all patients with OSA were men. CONCLUSIONS The prevalence of OSA in patients with PE seemed to be higher than that previously reported in the general population, implying that OSA might be a potential etiology or, at least, an aggravating factor for the development or progression of PE or might be responsible for the postoperative recurrence of PE in some patients. Further studies are needed to clarify this relationship.
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Affiliation(s)
- Yeung-Leung Cheng
- Division of Thoracic Surgery, Department of Surgery, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei, Taiwan
- School of Medicine, Tzu Chi University, Hualien, Taiwan
| | - I-Shiang Tzeng
- Department of Research, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei, Taiwan
| | - Mei-Chen Yang
- School of Medicine, Tzu Chi University, Hualien, Taiwan
- Division of Pulmonary Medicine, Department of Internal Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei, Taiwan
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Cheng YL, Lan CC, Wu YK, Su WL, Yang MC. Poorer sleep quality among adult patients with pectus excavatum in Taiwan: A pilot study. J Thorac Cardiovasc Surg 2018; 157:769-780.e1. [PMID: 30195589 DOI: 10.1016/j.jtcvs.2018.07.050] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Revised: 06/29/2018] [Accepted: 07/14/2018] [Indexed: 11/20/2022]
Abstract
OBJECTIVES Patients with pectus excavatum have a poorer quality of life than the general population. Sleep quality is a critical component of quality of life. This pilot study compared the sleep quality of adult patients with pectus excavatum with that of the general population in Taiwan. METHODS Participants comprised 30 healthy adults, 21 adult outpatients with pectus excavatum, and 33 adults with pectus excavatum receiving Nuss surgery. The Pittsburgh Sleep Quality Index measured subjective sleep quality; the Visual Analog Scale for Pain, Brief Symptom Rating Scale-5, Beck Depression Inventory II, and 36-Item Short Form Survey measured quality of life; and the Epworth Sleepiness Scale measured excessive daytime sleepiness. Outcome measurements were obtained at baseline for all groups and 6 months after Nuss surgery for inpatients. RESULTS Patients with pectus excavatum had poorer sleep quality and worse quality of life than controls. Poorer sleep quality was not related to the severity of pectus excavatum per se, but to psychologic issues (beta = 0.18, P < .001 in multiple linear regression analysis). Measurement time had no effect on sleep quality (beta = 0.31, P = .594 for outpatient group; beta = 0.27, P = .665 for inpatients). Sleep quality of patients with pectus excavatum improved after Nuss surgery (Pittsburgh Sleep Quality Index: 4 vs 7, P = .002). CONCLUSIONS Our findings suggested an association between poor sleep quality and pectus excavatum; thus, sleep quality should be evaluated before and after the Nuss procedure.
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Affiliation(s)
- Yeung-Leung Cheng
- Division of Thoracic Surgery, Department of Surgery, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City, Taiwan; School of Medicine, Tzu Chi University, Hualien, Taiwan
| | - Chou-Chin Lan
- School of Medicine, Tzu Chi University, Hualien, Taiwan; Division of Pulmonary Medicine, Department of Internal Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City, Taiwan
| | - Yao-Kuang Wu
- School of Medicine, Tzu Chi University, Hualien, Taiwan; Division of Pulmonary Medicine, Department of Internal Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City, Taiwan
| | - Wen-Lin Su
- School of Medicine, Tzu Chi University, Hualien, Taiwan; Division of Pulmonary Medicine, Department of Internal Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City, Taiwan
| | - Mei-Chen Yang
- School of Medicine, Tzu Chi University, Hualien, Taiwan; Division of Pulmonary Medicine, Department of Internal Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City, Taiwan.
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Del Do M, Song SA, Nesbitt NB, Spaw MC, Chang ET, Liming BJ, Cable BB, Camacho M. Supraglottoplasty surgery types 1-3: A practical classification system for laryngomalacia surgery. Int J Pediatr Otorhinolaryngol 2018; 111:69-74. [PMID: 29958617 DOI: 10.1016/j.ijporl.2018.05.022] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Revised: 05/17/2018] [Accepted: 05/17/2018] [Indexed: 10/16/2022]
Abstract
OBJECTIVE The objective of this study is to review the published literature on supraglottoplasty techniques for correcting laryngomalacia, and to subsequently provide a standardized classification system. METHODS Three authors independently and systematically searched Pubmed/MEDLINE and six additional databases for all studies that included descriptions of supraglottoplasty techniques for correcting laryngomalacia. Sub-sites operated on and specific technique descriptions were reviewed, cataloged and subsequently categorized. This data was then used to develop a new classification system. RESULTS 231 articles were identified, downloaded and reviewed in full text. 53 articles with 1669 patients from the included articles described in detail the supraglottoplasty procedure. 84 articles with 5731 patients had to be excluded secondary to not providing detail about the supraglottoplasty procedure. The resultant data identifies the need for a more standardized reporting of the supraglottoplasty procedure in order to more accurately evaluate technique specific outcomes. Currently 77% of the patients in the literature cannot be assessed for outcomes as they did not describe the details for the procedures. Eight variations of supraglottoplasty and four variations of epiglottis surgery were described. Based on the literature, we consolidated the surgery into the following types: Type 1: Debulking of arytenoids, Type 2: Division of aryepiglottic folds, Type 3: Epiglottis surgery. CONCLUSION This descriptive review identified 53 articles with 1669 patients from the included articles detailing multiple variations of supraglottoplasty techniques. The new classification supplements a previously established system describing laryngomalacia, and simplifies the supraglottoplasty into three descriptive and logical types of categories. Our classification system would give surgeons a universal language to describe the supraglottoplasty performed, which could improve reporting of techniques, and facilitate future communication and research.
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Affiliation(s)
- Michael Del Do
- Otolaryngology-Head and Neck Surgery, 1 Jarrett White Road, Tripler Army Medical Center, HI, 96859, USA.
| | - Sungjin A Song
- Otolaryngology-Head and Neck Surgery, 1 Jarrett White Road, Tripler Army Medical Center, HI, 96859, USA
| | - Nicholas B Nesbitt
- School of Medicine, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Rd, Bethesda, MD, 20814, USA
| | - Mark C Spaw
- Otolaryngology-Head and Neck Surgery, 1 Jarrett White Road, Tripler Army Medical Center, HI, 96859, USA
| | - Edward T Chang
- Otolaryngology-Head and Neck Surgery, 1 Jarrett White Road, Tripler Army Medical Center, HI, 96859, USA
| | - Bryan J Liming
- Otolaryngology-Head and Neck Surgery, Division of Pediatric Otolaryngology, 1 Jarrett White Road, Tripler Army Medical Center, HI, 96859, USA.
| | - Benjamin B Cable
- Otolaryngology-Head and Neck Surgery, Division of Pediatric Otolaryngology, 1 Jarrett White Road, Tripler Army Medical Center, HI, 96859, USA
| | - Macario Camacho
- Otolaryngology-Head and Neck Surgery, Division of Sleep Surgery and Medicine, 1 Jarrett White Road, Tripler Army Medical Center, HI, 96859, USA.
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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. [PMID: 27368437 DOI: 10.1016/j.ijporl.2016.05.015] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2016] [Revised: 04/20/2016] [Accepted: 05/15/2016] [Indexed: 12/26/2022]
Abstract
OBJECTIVE To comprehensively review changes in sleep parameters and the success rate of supraglottoplasty for treating obstructive sleep apnea (OSA) in children. In particular, to elucidate treatment modalities and factors affecting treatment outcomes in children with both laryngomalacia and OSA. METHODS The study protocol was registered on PROSPERO (CRD42015027053). Two authors independently searched databases including PubMed, MEDLINE, EMBASE, and the Cochrane Review database. The keywords were "supraglottoplasty," "laryngomalacia," "OSA," "polysomnography," "child," and "humans." Supraglottoplasty served as the primary treatment for OSA or secondary treatment for persistent disease after previous surgeries. Subgroup analyses were conducted for children receiving supraglottoplasty as the primary or secondary treatment for OSA, and for children with and without comorbidities. RESULTS Eleven studies with 121 patients were analyzed (mean age: 3.7 years; 64% boys; mean sample size: 11 patients). After surgery, the mean differences between the pre- and postoperative measurements were a significant reduction of 8.9 events/h in the apnea-hypopnea index (AHI) and an increase of 3.7% in minimum oxygen saturation (MinSaO2; P < 0.05). The overall success rate was 28% according to a postoperative AHI <1 and 72% according to an AHI <5. Children receiving supraglottoplasty as the primary treatment had significantly younger ages (0.6 vs 6.4 years P < 0.001) than those receiving supraglottoplasty as the secondary treatment, but the outcomes were similar (33% vs 19% for a postoperative AHI < 1, P = 0.27; 77% vs 61% for a postoperative AHI < 5, P = 0.233). Moreover, children with comorbidities, compared with those without, had a similar success rate according to a postoperative AHI <1 (25% vs 21%, P = 0.805) and postoperative AHI <5 (62% vs 84%, P = 0.166). CONCLUSIONS Supraglottoplasty is an effective surgery for AHI reduction and MinSaO2 increase in children with OSA and laryngomalacia. However, complete resolution of OSA is not achieved in most cases, and factors affecting treatment outcomes in these children require future studies.
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Affiliation(s)
- Chia-Fan Lee
- Speech Language Pathologist, Child Developmental Assessment and Intervention Center, Taipei City Hospital, Taipei, Taiwan, ROC
| | - Wei-Chung Hsu
- Department of Otolaryngology, National Taiwan University Hospital, Taipei, Taiwan, ROC; Sleep Center, National Taiwan University Hospital, Taipei, Taiwan, ROC
| | - Chia-Hsuan Lee
- Department of Otolaryngology, Taipei Hospital, Ministry of Health and Welfare, New Taipei City, Taiwan, ROC
| | - Ming-Tzer Lin
- Sleep Center, National Taiwan University Hospital, Taipei, Taiwan, ROC; Department of Internal Medicine, Hsiao Chung-Cheng Hospital, New Taipei, Taiwan, ROC.
| | - Kun-Tai Kang
- Department of Otolaryngology, Taipei Hospital, Ministry of Health and Welfare, New Taipei City, Taiwan, ROC.
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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. [PMID: 26968058 DOI: 10.1016/j.ijporl.2016.01.028] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2015] [Revised: 01/21/2016] [Accepted: 01/23/2016] [Indexed: 11/29/2022]
Abstract
INTRODUCTION AND OBJECTIVES Laryngomalacia (LM) is the most common cause of congenital stridor. Tradition holds that the majority of patients resolve spontaneously by 12-18 months of age. The objective of this study was to systematically review the literature on the spontaneous resolution of LM and/or its presenting symptoms, in otherwise healthy infants. METHODS Data sources included Medline/PubMed, EMBASE, Scopus, CINAHL, Proquest, Cochrane database, Cochrane Methodology Register, Web of Science Conference Proceedings Citation Index, and ACP Journal Club. Study inclusion criteria included participants with an endoscopic diagnosis of LM, and symptoms of stridor, swallowing dysfunction, and/or snoring/sleep-disordered breathing, that documented subjective or objective resolution endpoints. Surgical series, case reports, and narrative reviews were excluded. Studies with insufficient follow-up (<3 months), and patients with comorbidities without subgroup analysis were excluded. Two independent reviewers extracted follow-up duration, rate of retention, time to resolution of LM, and method of documentation of resolution. RESULTS Of the 1146 articles identified, three met inclusion/exclusion criteria (n=411 patients). All were retrospective and used stridor resolution as the only endpoint. Resolution rate was 89%, with time to resolution ranging from 4 to 42 months. Level of evidence was low, and studies suffered from lack of follow-up, and no objective endpoints. Meta-analysis was not possible. CONCLUSIONS Endoscopic evidence of the natural history of laryngomalacia and its resolution is lacking. Low level of evidence supports that stridor and respiratory distress resolve, but the range of the time to resolution and rate of resolution is wide. Other clinical manifestations have not been studied. Prospective longitudinal trials are required to better understand the natural history.
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Affiliation(s)
- Andre Isaac
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Alberta, Edmonton, AB, Canada.
| | - Han Zhang
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Alberta, Edmonton, AB, Canada
| | - Sue Rene Soon
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Alberta, Edmonton, AB, Canada; Division of Pediatric Surgery, Department of Pediatrics, The Stollery Children's Hospital, Edmonton, AB, Canada
| | - Sandra Campbell
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Hamdy El-Hakim
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Alberta, Edmonton, AB, Canada; Division of Pediatric Surgery, Department of Pediatrics, The Stollery Children's Hospital, Edmonton, AB, Canada
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Lee CF, Lee CH, Kang KT, Hsu WC. In reference to supraglottoplasty for laryngomalacia with obstructive sleep apnea: A systematic review and meta-analysis. Laryngoscope 2016; 126:E263. [DOI: 10.1002/lary.25950] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Chia-Fan Lee
- Child Developmental Assessment and Intervention Center; Taipei City Hospital; Taipei Taiwan
| | - Chia-Hsuan Lee
- Department of Otolaryngology, Taipei Hospital; Ministry of Health and Welfare; New Taipei City Taiwan
| | - Kun-Tai Kang
- Department of Otolaryngology, Taipei Hospital; Ministry of Health and Welfare; New Taipei City Taiwan
| | - Wei-Chung Hsu
- Department of Otolaryngology; National Taiwan University Hospital; Taipei Taiwan
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Camacho M, Dunn B, Torre C, Sasaki J, Gonzales R, Liu SYC, Chan DK, Certal V, Cable BB. Supraglottoplasty for laryngomalacia with obstructive sleep apnea: A systematic review and meta-analysis. Laryngoscope 2015; 126:1246-55. [PMID: 26691675 DOI: 10.1002/lary.25827] [Citation(s) in RCA: 57] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/16/2015] [Indexed: 11/09/2022]
Abstract
OBJECTIVES/HYPOTHESIS To determine if apnea-hypopnea index (AHI) and lowest oxygen saturation (LSAT) improve following isolated supraglottoplasty for laryngomalacia with obstructive sleep apnea (OSA) in children. STUDY DESIGN Systematic review and meta-analysis. METHODS Nine databases, including PubMed/MEDLINE, were searched through September 30, 2015. RESULTS A total of 517 studies were screened; 57 were reviewed; and 13 met criteria. One hundred thirty-eight patients were included (age range: 1 month-12.6 years). Sixty-four patients had sleep exclusive laryngomalacia, and in these patients: 1) AHI decreased from a mean (M) ± standard deviation (SD) of 14.0 ± 16.5 (95% confidence interval [CI] 10.0, 18.0) to 3.3 ± 4.0 (95% CI 2.4, 4.4) events/hour (relative reduction: 76.4% [95% CI 53.6, 106.4]); 2) LSAT improved from a M ± SD of 84.8 ± 8.4% (95% CI 82.8, 86.8) to 87.6 ± 4.4% (95% CI 86.6, 88.8); 3) standardized mean differences (SMD) demonstrated a small effect for LSAT and a large effect for AHI; and 4) cure (AHI < 1 event/hour) was 10.5% (19 patients with individual data). Seventy-four patients had congenital laryngomalacia, and in these patients: 1) AHI decreased from a M ± SD of 20.4 ± 23.9 (95% CI 12.8, 28.0) to 4.0 ± 4.5 (95% CI 2.6, 5.4) events/hour (relative reduction: 80.4% [95% CI 46.6, 107.4]); 2) LSAT improved from a M ± SD of 74.5 ± 11.9% (95% CI 70.9, 78.1) to 88.4 ± 6.6% (95% CI 86.4, 90.4); 3) SMD demonstrated a large effect for both AHI and LSAT; and 4) cure was 26.5% (38 patients with individual data). CONCLUSION Supraglottoplasty has improved AHI and LSAT in children with OSA and either sleep exclusive laryngomalacia or congenital laryngomalacia; however, the majority of them are not cured. Laryngoscope, 126:1246-1255, 2016.
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Affiliation(s)
- Macario Camacho
- Otolaryngology-Head and Neck Surgery, Division of Sleep Surgery and Medicine, Tripler Army Medical Center, Honolulu, Hawaii.,Department of Psychiatry and Behavioral Sciences, Sleep Medicine Division, Stanford Hospital and Clinics, Stanford Hospital and Clinics, Stanford, California, U.S.A
| | - Brandyn Dunn
- John A. Burns School of Medicine, University of Hawaii, Honolulu, Hawaii
| | - Carlos Torre
- Department of Otolaryngology-Head and Neck Surgery, Division of Sleep Surgery, Stanford Hospital and Clinics, Stanford, California, U.S.A
| | - Jodie Sasaki
- John A. Burns School of Medicine, University of Hawaii, Honolulu, Hawaii
| | - Raymond Gonzales
- Department of Otorhinolaryngology/Sleep Medicine Centre-Hospital CUF, University of Porto, Porto, Portugal
| | - Stanley Yung-Chuan Liu
- Department of Otolaryngology-Head and Neck Surgery, Division of Pediatric Otolaryngology, University of California San Francisco, San Francisco, California, U.S.A
| | - Dylan K Chan
- School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland, U.S.A
| | - Victor Certal
- CINTESIS-Centre for Research in Health Technologies and Information Systems, University of Porto, Porto, Portugal
| | - Benjamin B Cable
- Otolaryngology-Head and Neck Surgery, Division of Sleep Surgery and Medicine, Tripler Army Medical Center, Honolulu, Hawaii
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Gazzaz MJ, El-Hakim H. A case of acquired laryngomalacia in an infant, with endoscopy before and after establishing the diagnosis for the first time. BMJ Case Rep 2015; 2015:bcr-2015-213264. [PMID: 26628452 DOI: 10.1136/bcr-2015-213264] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A 12-week-old infant girl born at 27 weeks gestation, with multiple comorbidities, was referred to the paediatric otolaryngology team due to stridor and feeding difficulties. Initial airway endoscopy was performed, showing no abnormal findings. The infant underwent frequent hospitalisations for recurrent cyanotic spells. Despite initial laryngoscopy and bronchoscopy not showing abnormalities, a repeat endoscopy demonstrated laryngomalacia, significant enough to require a supraglottoplasty. This is the first report to confirm, with video evidence, that some cases of laryngomalacia are acquired rather than congenital, even in infancy.
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Affiliation(s)
- Malak Jamal Gazzaz
- Department of Otolaryngology-Head and Neck Surgery, University of Alberta, Edmonton, Alberta, Canada
| | - Hamdy El-Hakim
- Department of Pediatric Otolaryngology, University of Alberta, Edmonton, Alberta, Canada
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Liu C, Ulualp SO. Type I Chiari malformation presenting with laryngomalacia and dysphagia. Pediatr Int 2015; 57:795-7. [PMID: 26031456 DOI: 10.1111/ped.12639] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2014] [Revised: 08/14/2014] [Accepted: 01/15/2015] [Indexed: 12/01/2022]
Abstract
We describe clinical features of an infant with laryngomalacia and dysphagia caused by type I Chiari malformation (CM-I). A 12-month-old child presented with a 6 month history of progressive stridor, dysphagia, and gastroesophageal reflux. Examination of the airway and swallowing function indicated mild laryngomalacia and aspiration with all consistencies. Magnetic resonance imaging of the brain indicated CM-I. Symptoms were resolved after posterior fossa decompression. CM-I, typically diagnosed later in life, should be considered in the differential diagnosis of laryngomalacia and dysphagia. High clinical suspicion and thorough search for abnormalities ensure early diagnosis and proper management of children with neurologic variant laryngomalacia.
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Affiliation(s)
- Christopher Liu
- Department of Otolaryngology-Head and Neck Surgery, University of Texas Southwestern Medical Center
| | - Seckin O Ulualp
- Department of Otolaryngology-Head and Neck Surgery, University of Texas Southwestern Medical Center.,Children's Medical Center, Dallas, Texas, USA
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