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Mnatsakanian A, John J, Costeloe A, Minutello K, Shifman H, Thottam P, Haupert M. Post-operative safety of pediatric supraglottoplasty: Is post-operative admission necessary? Am J Otolaryngol 2024; 45:104171. [PMID: 38101128 DOI: 10.1016/j.amjoto.2023.104171] [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: 10/04/2023] [Accepted: 12/05/2023] [Indexed: 12/17/2023]
Abstract
OBJECTIVES The purpose of this study was to determine the incidence of adverse events in the first 48 h (acute) 14 days (subacute) in post supraglottoplasty pediatric patients. A secondary aim was to determine if postoperative hospital admission after supraglottoplasty in pediatric patients is necessary. METHODS This study was a retrospective review of pediatric patients who underwent supraglottoplasty at a tertiary care center. Data were obtained from January 2017-December 2020, totaling 107 patients. Pediatric patients who underwent supraglottoplasty were included in the study. Information regarding patients' demographics, length of postoperative hospital stay, comorbid conditions, unit of hospital admission, intraoperative and postoperative adverse events, and readmission within the first 14 days was gathered and analyzed. RESULTS The incidence of postoperative adverse events for all subjects after supraglottoplasty was 5.7 % (N = 6). The most common postoperative complications were respiratory distress (N = 2), followed by substernal retractions, stridor, and decreased oral intake (N = 1). There was no statistically significant increased incidence in any group of patients, regardless of their unit of stay post-operatively (p = 0.39). CONCLUSIONS Supraglottoplasty is a safe surgical option for patients with severe laryngomalacia. While each patient's care is individualized, we demonstrate that post-operative hospital admission is not necessary for healthy children undergoing supraglottoplasty. LEVEL OF EVIDENCE III - This is a retrospective chart review.
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Affiliation(s)
- Ani Mnatsakanian
- Department of Otolaryngology - Head and Neck Surgery, Ascension Macomb-Oakland Hospital, Madison Heights, MI, USA
| | - Jithin John
- Department of Otolaryngology - Head and Neck Surgery, Detroit Medical Center, Detroit, MI, USA
| | - Anya Costeloe
- Department of Otolaryngology - Head and Neck Surgery, Ascension Macomb-Oakland Hospital, Madison Heights, MI, USA
| | - Katrina Minutello
- Department of Otolaryngology-Head and Neck Surgery, McLaren Oakland Hospital, Pontiac, MI, USA
| | - Holly Shifman
- Department of Otolaryngology - Head and Neck Surgery, Detroit Medical Center, Detroit, MI, USA
| | - Prasad Thottam
- Beaumont Hospital, Royal Oak, MI, USA; Michigan Pediatric Ear Nose and Throat Associates, West Bloomfield Township, MI, USA
| | - Michael Haupert
- Beaumont Hospital, Royal Oak, MI, USA; Michigan Pediatric Ear Nose and Throat Associates, West Bloomfield Township, MI, USA.
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Drummond RL, Padoin RCPK, Salgueiro BD, Lubianca Neto JF. Efficacy and predictors of success on laryngomalacia surgery: experience from a tertiary pediatric care center in Brazil. Braz J Otorhinolaryngol 2023; 89:101315. [PMID: 37716096 PMCID: PMC10509652 DOI: 10.1016/j.bjorl.2023.101315] [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: 05/31/2023] [Revised: 08/01/2023] [Accepted: 08/17/2023] [Indexed: 09/18/2023] Open
Abstract
OBJECTIVES Laryngomalacia is the most common congenital cause of stridor; the natural history of the disease runs through to complete resolution by the age of two. Severe cases are characterized by cyanosis, hypoxia, apnea, furcular and/or subcostal retractions, aspirations, pulmonary hypertension, and failure to thrive and must undergo surgery. This study aimed to evaluate the success rates of supraglottoplasty in our hospital and evaluate the predictive factors for surgical success. METHODS Cohort study, prospectively planned. 75 patients undergoing endoscopic surgery from July 2007 to July 2016 were analyzed at the Santo Antônio Children's Hospital. The primary outcome was percentage of surgical success, defined as the absence of respiratory symptoms or presence of a mild stridor without retractions on the first post-operative month (late success). The secondary outcomes were the early surgical success (absence of respiratory symptoms or presence of a mild stridor without retractions on the first post-operative day). RESULTS 39 (58.2%) were male, with an average of 4.9 months. Surgical success on the first day was 80.6% (n=54). At the end of the 1st month, surgical success was 88.6%, considering only those who completed assessment. Twenty-one (34%) presented comorbidities. Presence of comorbidities, pharyngomalacia and GERD were associated with a worse result on the 1st postoperative day, whereas, at the end of the first month, presence of comorbidities, concomitant injuries (tracheo and bronchomalacia) and pharyngomalacia were the predictive variables of surgery failure. CONCLUSION Supraglottoplasty has high rates of efficacy and low morbidity. The presence of comorbidities and pharyngomalacia has shown association with a worse early and late surgical outcome. Synchronous airway lesions predict a worse surgical result at the end of the first month. GERD was associated with obstructive symptomatology only in the 1st post-operative day. LEVEL OF EVIDENCE Level 3 of evidence, according to the "The Oxford 2011 Levels of Evidence" from Oxford Centre for Evidence-Based Medicine.
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Affiliation(s)
- Renata Loss Drummond
- Santa Casa de Misericórdia de Porto Alegre (UFCSPA), Serviço de Otorrinolaringologia e do Programa de Residência Médica em Otorrinolaringologia, Porto Alegre, RS, Brazil; Hospital da Criança Santo Antônio, Serviço de Otorrinolaringologia Pediátrica, Programa de Fellowship em Otorrinolaringologia Pediátrica, Porto Alegre, RS, Brazil
| | - Rita Carolina Pozzer Krumenauer Padoin
- Santa Casa de Misericórdia de Porto Alegre (UFCSPA), Serviço de Otorrinolaringologia e do Programa de Residência Médica em Otorrinolaringologia, Porto Alegre, RS, Brazil; Hospital da Criança Santo Antônio, Serviço de Otorrinolaringologia Pediátrica, Programa de Fellowship em Otorrinolaringologia Pediátrica, Porto Alegre, RS, Brazil
| | - Bárbara Duarte Salgueiro
- Hospital da Criança Santo Antônio, Serviço de Otorrinolaringologia Pediátrica, Programa de Fellowship em Otorrinolaringologia Pediátrica, Porto Alegre, RS, Brazil.
| | - José Faibes Lubianca Neto
- Santa Casa de Misericórdia de Porto Alegre (UFCSPA), Serviço de Otorrinolaringologia e do Programa de Residência Médica em Otorrinolaringologia, Porto Alegre, RS, Brazil; Hospital da Criança Santo Antônio, Serviço de Otorrinolaringologia Pediátrica, Programa de Fellowship em Otorrinolaringologia Pediátrica, Porto Alegre, RS, Brazil; Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Disciplina de Otorrinolaringologia (ORL) e Programa de Pós-Graduação em Pediatria, Porto Alegre, RS, Brazil
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Arbona DV, Pratt C, Tearney C, Istvan S. A case of epiglottic entrapment in a cat. Vet Med Sci 2023; 9:1953-1958. [PMID: 37465985 PMCID: PMC10508545 DOI: 10.1002/vms3.1211] [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: 11/23/2022] [Revised: 04/25/2023] [Accepted: 07/06/2023] [Indexed: 07/20/2023] Open
Abstract
OBJECTIVE The objective of this study was to describe a case of epiglottic entrapment in a cat. CASE SUMMARY A 5-month-old male neutered Russian Blue cat was evaluated for progressive stertorous upper airway sounds, acute onset vestibulopathy and abnormal laryngeal anatomy. Endotracheal intubation was only able to be achieved using videoscopic guidance and identified concern for severe nasopharyngeal stenosis. A computerized tomography scan revealed otitis interna, narrowed nasopharynx and no definitive cause for the stertorous breathing. The cat recovered very slowly from anaesthesia due to concern for airway obstruction following extubation. It was discharged the following day and then passed away at home 2 weeks later. Necropsy revealed that the epiglottis was obscured by 2 cm of redundant mucosal tissue extending from the base of the tongue to the larynx resulting in epiglottic entrapment. Also noted was chronic, severe otitis interna and externa. Upper airway obstruction is suspected to be the cause of sudden death. NEW OR UNIQUE INFORMATION To the authors' knowledge, this is the first report of these oropharyngeal anatomic abnormalities in a cat.
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Affiliation(s)
| | - Chap Pratt
- Colorado Animal Specialty and EmergencyCritical CareBoulderColoradoUSA
| | - Caitlin Tearney
- Veterinary Medical Center: AnesthesiaUniversity of Minnesota College of Veterinary MedicineSt. PaulMinnesotaUSA
| | - Stephanie Istvan
- Veterinary Specialty Hospital – Sorrento ValleySan DiegoCaliforniaUSA
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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: 0] [Impact Index Per Article: 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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A novel sleep oximetry scoring tool for pediatric laryngomalacia. Int J Pediatr Otorhinolaryngol 2022; 160:111220. [PMID: 35816969 DOI: 10.1016/j.ijporl.2022.111220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 05/24/2022] [Accepted: 06/22/2022] [Indexed: 11/23/2022]
Abstract
OBJECTIVE Despite being a more accessible and less resource intensive modality than polysomnography, the utility of sleep oximetry (SO) in pediatric laryngomalacia (LM) is not well understood or validated. We aimed to retrospectively evaluate the utility of overnight home based SO in children with LM by developing and internally validating the Modified Laryngomalacia Oximetry Score (MLOS) scoring system to triage severity and guide clinical decision making. METHODS We evaluated pediatric patients with a diagnosis of LM at our tertiary referral centre. Data from initial and post-treatment SO including mean oxygen saturation (spO2) nadir and mean oxygen desaturation index (ODI) were aggregated. The MLOS ranging from I-VI (inconclusive to severe) was created by two otolaryngologists to incorporate bradycardia associated desaturation events during SO. Corresponding McGill Oximetry Score (MOS) was also determined. RESULTS 172 patients were included in final analysis. The average age was 9.2 ± 14.3 months. 98 (57%) of patients were identified as Thompson severity score 1, and 87 (50.6%) of patients underwent supraglottoplasty. The surgical cohort had a significantly higher MLOS and MOS scores of 4 and 2 respectively, and higher mean ODI and spO2 nadir metrics. When evaluating post-supraglottoplasty SO tracings, all parameters improved significantly, including median MLOS score from 4 to 1. Only the mean ODI improved in the non-surgical cohort. Patients with Thompson severity score 2/3 had significantly higher MLOS. CONCLUSION We present a simple scoring system based on overnight SO, the MLOS, to help triage severity of pediatric LM and guide decision-making. MLOS is associated with worse clinical severity and a need for surgery, and shows significant improvement after surgery.
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El-Sobki A, Ibrahim RAE, Amer A, Hashish MI, El-Deeb ME, El-Kholy NA, Abdelmeguid AS. Coblation supraglottoplasty: a ten-year experience in a tertiary referral hospital. Eur Arch Otorhinolaryngol 2021; 279:865-874. [PMID: 34654950 DOI: 10.1007/s00405-021-07130-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 10/06/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE The present study aims to review the outcomes of coblation supraglottoplasty performed for children with different types of laryngomalacia, and we discuss the factors affecting these outcomes. METHODS We retrospectively reviewed the medical records of laryngomalacia patients admitted to the Otorhinolaryngology Department, Mansoura University, from 2010 to 2020. We examined the patient's demography, symptoms, comorbidities, type of laryngomalacia, oxygen saturation, and final outcomes. RESULTS Our study included 235 patients; 122 patients responded to medical therapy, while 113 underwent surgical management. There is a significant relation between the types and therapy they underwent (p ≤ 0.001). Larger percentage within type I underwent medical therapy. There is a statistically significant difference between the studied groups regarding age at surgery. On pairwise comparison, patients with type II had the lowest age significantly at the surgery when compared with each other individual group (p ≤ 0.001). On multivariate regression analysis, the presence of comorbid congenital heart disease, neurological comorbidities significantly increased the risk of failure of surgical intervention by 17.32 and 5.803 folds, respectively. CONCLUSIONS Coblation supraglottoplasty is effective and safe to treat severe laryngomalacia. Different morphological types of laryngomalacia require slight surgical variations of coblation supraglottoplasty. The presence of comorbid congenital heart disease, neurological comorbidities significantly increased the risk of failure of surgical intervention.
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Affiliation(s)
- Ahmed El-Sobki
- Otorhinolaryngology Department, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Reham A E Ibrahim
- Phoniatrics Unit, Otorhinolaryngology Department, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Ayman Amer
- Phoniatrics Unit, Otorhinolaryngology Department, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | | | - Mohamed E El-Deeb
- Otorhinolaryngology Department, Faculty of Medicine, Kafrelsheikh University, El-giesh Street, Kafrelsheikh, Egypt.
| | - Noha Ahmed El-Kholy
- Otorhinolaryngology Department, Faculty of Medicine, Mansoura University, Mansoura, Egypt
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Johnson LR, Mayhew PD, Culp WTN, Stanley BJ. Results of owner questionnaires describing long-term outcome in Norwich terriers with upper airway syndrome: 2011-2018. J Vet Intern Med 2021; 35:1950-1956. [PMID: 34076315 PMCID: PMC8295680 DOI: 10.1111/jvim.16180] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Revised: 05/07/2021] [Accepted: 05/18/2021] [Indexed: 11/30/2022] Open
Abstract
Background Norwich terriers are affected by an upper airway syndrome (NTUAS) but little is known about outcome in affected dogs. Objective To determine outcome in dogs with NTUAS using owner questionnaires. Animals Thirty‐four client‐owned dogs. Methods At initial assessment, owners were questioned about respiratory noises and exercise tolerance. A NTUAS score was prospectively constructed based on the number and severity of obstructive lesions detected endoscopically (range, 0‐25). Owner questionnaires on respiratory noises, exercise tolerance, and quality of life (QOL) were obtained 2.2‐9.3 years (median, 4.2 years) after endoscopy. Results Dogs ranged from 0.5 to 10.7 years of age (median, 4.75 years) at initial examination and no correlation was found between age and NTUAS score (median, 13; range, 1‐25). Of 5 possible laryngeal abnormalities, 7 dogs had 1‐2, 10 dogs had 3, and 17 dogs had 4‐5 abnormalities (median, 3.5). Surgery was performed in 15 dogs, which had higher NTUAS scores (18.5 ± 6.3) than dogs that did not have surgery (7.7 ± 4.7, P < .0001). Scores for QOL ranged from 0 to 31 out of 40, with higher scores indicating worse QOL. Owner surveys resulted in QOL scores of ≤3 in 25/31 dogs (81%), with worse scores in dogs that had surgery performed (median 5, vs 0; P = .003). No correlation was noted between NTUAS and QOL scores, but age at follow‐up was weakly associated with worse QOL. Conclusions and Clinical Importance Despite variable severity of NTUAS scores, owners reported excellent QOL for most Norwich terriers examined.
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Affiliation(s)
- Lynelle R Johnson
- Department of Medicine and Epidemiology, University of California-Davis, Davis, California, USA
| | - Philipp D Mayhew
- Department of Surgical and Radiological Sciences, University of California-Davis, Davis, California, USA
| | - William T N Culp
- Department of Surgical and Radiological Sciences, University of California-Davis, Davis, California, USA
| | - Bryden J Stanley
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, Michigan State University, East Lansing, Michigan, USA
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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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Gan RWC, Moustafa A, Turner K, Knight L. Histopathology of laryngomalacia. Acta Otolaryngol 2021; 141:85-88. [PMID: 33393421 DOI: 10.1080/00016489.2020.1821246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Laryngomalacia is the commonest laryngeal anomaly and cause of stridor in children. Although most cases are self-limiting, failure to thrive, hypoxaemia or significant apnoeic episodes may warrant surgical intervention in the form of aryepiglottoplasty. Opinion is divided as to the pathophysiological mechanisms involved in the disease process. AIMS AND OBJECTIVES This study explores the aetiology of laryngomalacia by reviewing the histology of aryepiglottoplasty resection specimens. MATERIAL AND METHODS The histology reports of 61 aryepiglottoplasty specimens resected between 1 October 2014 and 31 October 2018 were reviewed. RESULTS Age of patients ranged from 3 weeks to 36 months. 36 patients were male and 25 female. 43 of 61 (70.5%) cases had inflammation, most of which were mild. 3 (4.9%) cases had histological specimens with detectable eosinophils. None of the specimens had signs of granulomatous change, ulceration or calcification. Cartilage was present in the resected specimen in 47 (77%) cases. Over half of these (59.6%) were immature cartilage. CONCLUSION AND SIGNIFICANCE The results suggest a mild concurrent laryngitis/supraglottitis in most cases. Eosinophilia is rare and does not support eosinophilic oesophageal reflux as part of the aetiology. The high proportion of immature cartilage in the specimens supports the theory of chondropathic aetiology.
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Affiliation(s)
| | - Ali Moustafa
- Ear, Nose and Throat Department, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Kerry Turner
- Cellular Pathology Department, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Lindsey Knight
- Ear, Nose and Throat Department, Leeds Teaching Hospitals NHS Trust, Leeds, UK
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Schmidt K, Moore C, Ettema S. Epiglotic anomaly yields reduced airway protection in an infant. OTOLARYNGOLOGY CASE REPORTS 2020. [DOI: 10.1016/j.xocr.2020.100168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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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: 2] [Impact Index Per Article: 0.5] [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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Cortes MC, Villamor P, de la Torre González C, Álvarez-Neri H. Complete polysomnographic parameters in infants with severe laryngomalacia prior to and after supraglottoplasty. Int J Pediatr Otorhinolaryngol 2019; 119:131-135. [PMID: 30708179 DOI: 10.1016/j.ijporl.2019.01.033] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Revised: 01/21/2019] [Accepted: 01/23/2019] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Laryngomalacia is the most common congenital laryngeal anomaly. Because of supraglottic prolapse, laryngomalacia may be associated with obstructive sleep apnea (OSA) and sleep disturbances. The effects of OSA and sleep disorders in children include failure to thrive, cognitive and behavioral disturbances, cardiovascular compromise, and an association with sudden infant death syndrome. OBJECTIVE To evaluate the presence of OSA and sleep disturbances in children with severe laryngomalacia through complete nocturnal polysomnography, as well as to establish the effects of supraglottoplasty in each of the polysomnographic parameters. RESULTS Nine infants with severe laryngomalacia were included, all with a complete polysomnographic study prior to and after supraglottoplasty. The average age was 5.5 months. All patients presented an Apnea-Hypopnea Index (AHI) within the range of severe OSA. After supraglottoplasty, a significant reduction in AHI was found, from 34.87 ± 20.34 to 9.44 ± 5.28 after surgery (p: 0.022). Additionally, sleep efficiency had a significant increase, from 21.4% to 56.29% of total sleep time (p: 0.0013). All patients presented a significant decrease in obstructive apnea episodes (p < 0.0001), as well as in hypopnea episodes (p: 0.0154). The mean and minimum peripheral oxygen saturation (SpO2) had a significant increase after supraglottoplasty from 88.2% to 94.09% (p: 0.0002), and from 81.01% to 89.33% (p < 0.0001), respectively. CONCLUSION Polysomnography (PSG) may provide better surgical sustenance in infants with severe laryngomalacia and OSA, as well as, serving as a monitoring tool of success. However, the surgical decision should not be reduced to polysomnographic results, and a good history and examination remain as the fundamental criteria.
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Affiliation(s)
- María Cristina Cortes
- Department of Pediatric Otolaryngology, Hospital Infantil de México, Federico Gómez, Mexico
| | - Perla Villamor
- Department of Pediatric Otolaryngology, Hospital Infantil de México, Federico Gómez, Mexico.
| | | | - Hiram Álvarez-Neri
- Department of Pediatric Otolaryngology, Hospital Infantil de México, Federico Gómez, Mexico
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Abstract
Stridor, a common presenting sign of respiratory distress in a newborn, has many systemic causes. It may arise from the larynx or the tracheobronchial airway. This article presents the most common pathologic conditions in this anatomic region, with highlights on management.
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Affiliation(s)
- Jay Bhatt
- Department of Pediatric Otolaryngology, Children's Hospital Colorado, 13123 E 16th Avenue, B-455, Aurora, CO 80045, USA
| | - Jeremy D Prager
- Department of Otolaryngology, University of Colorado School of Medicine, 12631 E. 17th Avenue, B-205, Aurora, CO 80045, USA.
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Abstract
Stridor is a high-pitched respiratory sound that signals upper airway obstruction. It can be encountered by clinicians in a variety of clinical settings and requires a team-based, interdisciplinary approach. Early recognition is crucial, as the differential diagnosis can be broad, and causes range from benign to life-threatening. This article reviews the most commonly encountered causes of chronic congenital stridor in infants, focusing on the diagnostic approach, pathophysiology, clinical presentation, and management strategies.
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15
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Kaditis AG, Alonso Alvarez ML, Boudewyns A, Abel F, Alexopoulos EI, Ersu R, Joosten K, Larramona H, Miano S, Narang I, Tan HL, Trang H, Tsaoussoglou M, Vandenbussche N, Villa MP, Van Waardenburg D, Weber S, Verhulst S. ERS statement on obstructive sleep disordered breathing in 1- to 23-month-old children. Eur Respir J 2017; 50:50/6/1700985. [PMID: 29217599 DOI: 10.1183/13993003.00985-2017] [Citation(s) in RCA: 91] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2017] [Accepted: 08/16/2017] [Indexed: 11/05/2022]
Abstract
The present statement was produced by a European Respiratory Society Task Force to summarise the evidence and current practice on the diagnosis and management of obstructive sleep disordered breathing (SDB) in children aged 1-23 months. A systematic literature search was completed and 159 articles were summarised to answer clinically relevant questions. SDB is suspected when symptoms or abnormalities related to upper airway obstruction are identified. Morbidity (pulmonary hypertension, growth delay, behavioural problems) and coexisting conditions (feeding difficulties, recurrent otitis media) may be present. SDB severity is measured objectively, preferably by polysomnography, or alternatively polygraphy or nocturnal oximetry. Children with apparent upper airway obstruction during wakefulness, those with abnormal sleep study in combination with SDB symptoms (e.g. snoring) and/or conditions predisposing to SDB (e.g. mandibular hypoplasia) as well as children with SDB and complex conditions (e.g. Down syndrome, Prader-Willi syndrome) will benefit from treatment. Adenotonsillectomy and continuous positive airway pressure are the most frequently used treatment measures along with interventions targeting specific conditions (e.g. supraglottoplasty for laryngomalacia or nasopharyngeal airway for mandibular hypoplasia). Hence, obstructive SDB in children aged 1-23 months is a multifactorial disorder that requires objective assessment and treatment of all underlying abnormalities that contribute to upper airway obstruction during sleep.
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Affiliation(s)
- Athanasios G Kaditis
- Paediatric Pulmonology Unit, First Dept of Paediatrics, National and Kapodistrian University of Athens School of Medicine and Aghia Sophia Children's Hospital, Athens, Greece
| | - Maria Luz Alonso Alvarez
- Multidisciplinary Sleep Unit, Pulmonology, University Hospital of Burgos and CIBER of Respiratory Diseases (CIBERES), Burgos Foundation for Health Research, Burgos, Spain
| | - An Boudewyns
- Dept of Otorhinolaryngology Head and Neck Surgery, Antwerp University Hospital, University of Antwerp, Antwerp, Belgium
| | - Francois Abel
- Dept of Respiratory Medicine, Great Ormond Street Hospital for Children, London, UK
| | - Emmanouel I Alexopoulos
- Sleep Disorders Laboratory, University of Thessaly School of Medicine and Larissa University Hospital, Larissa, Greece
| | - Refika Ersu
- Division of Paediatric Pulmonology, Marmara University, Istanbul, Turkey
| | - Koen Joosten
- Erasmus MC, Sophia Children's Hospital, Paediatric Intensive Care, Rotterdam, The Netherlands
| | - Helena Larramona
- Paediatric Pulmonology Unit, Dept of Paediatrics, University Autonoma of Barcelona, Corporacio Sanitaria Parc Tauli, Hospital of Sabadell, Barcelona, Spain
| | - Silvia Miano
- Sleep and Epilepsy Centre, Neurocentre of Southern Switzerland, Civic Hospital of Lugano, Lugano, Switzerland
| | - Indra Narang
- Division of Respiratory Medicine, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Hui-Leng Tan
- Dept of Paediatric Respiratory Medicine, Royal Brompton Hospital, London, UK
| | - Ha Trang
- Paediatric Sleep Centre, Robert Debré University Hospital, EA 7334 REMES Paris-Diderot University, Paris, France
| | - Marina Tsaoussoglou
- Paediatric Pulmonology Unit, First Dept of Paediatrics, National and Kapodistrian University of Athens School of Medicine and Aghia Sophia Children's Hospital, Athens, Greece
| | | | - Maria Pia Villa
- Paediatric Sleep Disease Centre, Child Neurology, NESMOS Dept, School of Medicine and Psychology, Sapienza University of Rome, S. Andrea Hospital, Rome, Italy
| | - Dick Van Waardenburg
- Paediatric Intensive Care Unit, Dept of Paediatrics, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Silke Weber
- Dept of Ophthalmology, Otolaryngology and Head and Neck Surgery, Botucatu Medical School, São Paulo State University-UNESP, Botucatu, São Paulo, Brazil
| | - Stijn Verhulst
- Dept of Paediatrics, Antwerp University Hospital, Edegem, Belgium
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16
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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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17
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Weinstein JE, Lawlor CM, Wu EL, Rodriguez KH. Utility of polysomnography in determination of laryngomalacia severity. Int J Pediatr Otorhinolaryngol 2017; 93:145-149. [PMID: 28109487 DOI: 10.1016/j.ijporl.2016.12.039] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Revised: 12/26/2016] [Accepted: 12/27/2016] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To examine the efficacy of polysomnography in determining the severity of laryngomalacia in pediatric patients. METHODS Prospective cohort study. Pediatric patients referred to our pediatric otolaryngology department with a polysomnogram already performed for a presumptive diagnosis of laryngomalacia were enrolled in the study. Patients with concurrent airway lesions or neuromuscular disorders were excluded. Patients underwent history, physical exam, and flexible fiberoptic laryngoscopy. These results were used to calculate a total laryngomalacia severity score. RESULTS 25 pediatric patients (n = 25) with an average age of 3.9 months at time of initial evaluation met criteria for enrollment in our study. 100% of patients had obstructive sleep apnea by definition. 80% of these patients underwent supraglottoplasty. The average AHI of those who underwent surgery (57.26) was not significantly different in those who underwent surgery vs. those that did not (55.43) (p = 0.41). In comparison, the average laryngomalacia severity score based from history, physical exam and flexible laryngoscopy was significantly greater in the patients that required supraglottoplasty (11.16) vs. those who did not (5.33) (p = 0.03). In addition a higher laryngomalacia severity score was not correlated with a higher AHI (p = 0.81, r = 0.08, CI: -0.5197 to 0.6235). CONCLUSION In our cohort, polysomnography was not useful in determining the severity of laryngomalacia, did not correlate with the clinical evaluation, and alone was not predictive of the patients that would require surgical intervention. History, physical exam, and endoscopic findings remain reliable predictors of disease severity and need for operative intervention.
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Affiliation(s)
- Jacqueline E Weinstein
- Tulane University School of Medicine, Department of Otolaryngology/Head and Neck Surgery, New Orleans, LA, USA
| | - Claire M Lawlor
- Tulane University School of Medicine, Department of Otolaryngology/Head and Neck Surgery, New Orleans, LA, USA.
| | - Eric L Wu
- Tulane University School of Medicine, Department of Otolaryngology/Head and Neck Surgery, New Orleans, LA, USA
| | - Kimsey H Rodriguez
- Tulane University School of Medicine, Department of Otolaryngology/Head and Neck Surgery, New Orleans, LA, USA; Ochsner Clinic Foundation, Department of Pediatric Otolaryngology, New Orleans, LA, USA
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18
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Olgun Y, Özay H, Çakır A, Erdağ TK. Laryngomalacia: Our Clinical Experience. Turk Arch Otorhinolaryngol 2016; 54:150-153. [PMID: 29392037 DOI: 10.5152/tao.2016.1852] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2016] [Accepted: 09/25/2016] [Indexed: 11/22/2022] Open
Abstract
Objective The aim of this study is to analyse the clinical symptoms, follow-up and treatment properties of the laryngomalacia patients that we encountered between 2009 and 2014. Methods Records of 81 laryngomalacia patients who were followed up in our clinic between 2009 and 2014 were retrospectively analysed. Patients' gender, age, time of onset of the symptoms, chief complaints, other co-existing congenital laryngeal anomalies and treatment and follow-up properties were evaluated. Results Of the 81 patients, 48 were male and 33 were female, and the mean age was 4.9 months. The average period of follow-up was 12.1 months. The chief complaints at the time of admission were stridor (100%) and episodic cyanosis with feeding (27.16%). Symptoms of 75 patients were resolved at an average of 8.2 months with conservative treatment. Three patients underwent supraglottoplasty. Tracheotomy and posterior cordotomy was performed for a patient with co-existing vocal cord paralysis. Additional tracheotomy was necessary for a patient with pulmonary co-morbidities and for another with co-existing subglottic stenosis. Conclusion Laryngomalacia is the most common cause of stridor in infants. The majority of laryngomalacia patients can be managed conservatively by close follow-up. For patients in whom respiratory and feeding problems persist or growth retardation develops, surgical treatment is performed. Tracheotomy may be necessary for a small group of patients with additional diseases.
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Affiliation(s)
- Yüksel Olgun
- Department of Otorhinolaryngology, Dokuz Eylül University School of Medicine, İzmir, Turkey
| | - Hüseyin Özay
- Department of Otorhinolaryngology, Dokuz Eylül University School of Medicine, İzmir, Turkey
| | - Aslı Çakır
- Department of Otorhinolaryngology, Dokuz Eylül University School of Medicine, İzmir, Turkey
| | - Taner Kemal Erdağ
- Department of Otorhinolaryngology, Dokuz Eylül University School of Medicine, İzmir, Turkey
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19
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Ramprasad VH, Ryan MA, Farjat AE, Eapen RJ, Raynor EM. Practice patterns in supraglottoplasty and perioperative care. Int J Pediatr Otorhinolaryngol 2016; 86:118-23. [PMID: 27260594 PMCID: PMC4894349 DOI: 10.1016/j.ijporl.2016.04.039] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2016] [Revised: 04/30/2016] [Accepted: 04/30/2016] [Indexed: 10/21/2022]
Abstract
OBJECTIVES Supraglottoplasty is the first-line surgical treatment for severe laryngomalacia. The purpose of this study is to determine the current trends of practice patterns in managing children who require supraglottoplasty. METHODS A 25-question survey regarding supraglottoplasty techniques and perioperative management was sent by e-mail to 274 physician members of the Society for Ear, Nose and Throat Advances in Children (SENTAC). RESULTS 101 surgeons responded and 72% of respondents were in academic practice (p < 0.0001). All four United States regions, Canada and the United Kingdom were represented. The most commonly reported age of patients undergoing supraglottoplasty was 1-3 months (62% of respondents). Indications include worsening airway symptoms (43%), failure to thrive (41%) and worsening feeding (10%). The majority of respondents (89%) treat these patients for reflux with 54% prescribing PPIs and 41% prescribing H2 blockers. Cold steel is the most popular surgical technique (73%) followed by laser (14%), microdebrider (10%) and coblator (3%) (p < 0.0001). Most respondents (92%) administer intraoperative steroids with the majority of them choosing dexamethasone (99%). Perioperative antibiotics are administered by 23% of respondents. Almost all respondents admit their patients for post-operative observation (99%) and 53% of these admit to PICU rather than step-down or floor status. The level of care is associated with the number of supraglottoplasties performed per year (p = 0.009) and with the geographic region (p = 0.02). Surgeons who perform fewer supraglottoplasties tend to admit to a higher level of care. Those in the South and Northeast regions tend to admit more to floor status. Only 13% routinely keep patients intubated post-operatively. CONCLUSIONS This provider survey study highlights some significant variations and trends in practice patterns of otolaryngologists who perform supraglottoplasty. The majority utilizes anti-reflux pharmacotherapy; however, there is no consensus in which type. The method for supraglottoplasty also varies with cold steel being the most popular, although no single method has been shown to be superior. There is variation in post-operative care with trends for keeping patients extubated and admitting them to an intensive care. With the importance of safe, effective, and also cost-conscious care, further studies are needed to understand the optimal management of those who undergo supraglottoplasty.
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Affiliation(s)
- Vaibhav H Ramprasad
- Division of Otolaryngology-Head and Neck Surgery and Communication Sciences, Department of Surgery, Duke University Medical Center, DUMC 3805, Durham, NC 27710, USA
| | - Marisa A Ryan
- Division of Otolaryngology-Head and Neck Surgery and Communication Sciences, Department of Surgery, Duke University Medical Center, DUMC 3805, Durham, NC 27710, USA.
| | - Alfredo E Farjat
- Department of Biostatics and Bioinformatics, Duke University School of Medicine, 2424 Erwin Road, Suite 1102 Hock Plaza, Box 2721, Durham, NC 27710, USA
| | - Rose J Eapen
- Division of Otolaryngology-Head and Neck Surgery and Communication Sciences, Department of Surgery, Duke University Medical Center, DUMC 3805, Durham, NC 27710, USA
| | - Eileen M Raynor
- Division of Otolaryngology-Head and Neck Surgery and Communication Sciences, Department of Surgery, Duke University Medical Center, DUMC 3805, Durham, NC 27710, USA
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20
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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: 52] [Impact Index Per Article: 5.8] [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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Cheng J, Smith LP. Endoscopic surgical management of inspiratory stridor in newborns and infants. Am J Otolaryngol 2015; 36:697-700. [PMID: 26119081 DOI: 10.1016/j.amjoto.2015.05.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2015] [Accepted: 05/27/2015] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Compare the incidence of endoscopic surgical treatment of patients with laryngomalacia to other aerodigestive pathology who may present with similar symptoms. METHODS Consecutive case series with chart review of endoscopic surgical intervention in infants, aged 12 months or less, presenting with inspiratory stridor, in the absence of syndromic condition or prior history of intubation. RESULTS A total of 30 patients were identified. The average age at the time of surgical intervention was 2.7 months. Endoscopic surgical management was directed at laryngomalacia (70%), vallecular cysts (23.3%), and anterior glottic webs (6.7%). All patients had nearly immediate resolution of the stridor and feeding difficulties. None required revision surgery, modified diets, or alternative means of enteric nutrition. CONCLUSIONS Laryngomalacia was the most commonly encountered surgical indication for stridulous newborns and infants with severe symptoms. Like most previous descriptions, patients responded well to supraglottoplasty. Vallecular cysts accounted for about one-quarter of the infants treated. Clinicians should carefully consider the presence of other airway pathology, which may mimic laryngomalacia, in non-syndromic infants without a previous history of intubation. Endoscopic surgical management may be safe and effective.
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Affiliation(s)
- Jeffrey Cheng
- Division of Pediatric Otolaryngology, Cohen Children's Medical Center, New Hyde Park, NY; Department of Otolaryngology, Head and Neck Surgery, Hofstra North Shore-LIJ School of Medicine, Hempstead, NY.
| | - Lee P Smith
- Division of Pediatric Otolaryngology, Cohen Children's Medical Center, New Hyde Park, NY; Department of Otolaryngology, Head and Neck Surgery, Hofstra North Shore-LIJ School of Medicine, Hempstead, NY
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22
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Czechowicz JA, Chang KW. Catch-up growth in infants with laryngomalacia after supraglottoplasty. Int J Pediatr Otorhinolaryngol 2015; 79:1333-6. [PMID: 26096747 DOI: 10.1016/j.ijporl.2015.06.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2015] [Revised: 06/03/2015] [Accepted: 06/04/2015] [Indexed: 11/30/2022]
Abstract
IMPORTANCE Laryngomalacia, the most common congenital anomaly of the infant airway, can lead to poor feeding and failure to thrive. The decision to perform the standard surgical treatment, supraglottoplasty, is often based upon a sustained period of poor weight gain or weight loss. OBJECTIVE To characterize patterns of growth in infants with laryngomalacia, preceding and following supraglottoplasty. DESIGN Retrospective chart review. Bioinformatics techniques were used to procure data from a clinical data warehouse based on the HL7 Reference Information Model consisting of all infants who underwent supraglottoplasty from June 1, 2005 to October 31, 2013. Height and weight measurements were obtained from 76 operated patients allowing for characterization of growth changes from the time of surgery to an average of 9 months following surgery. Logistic regression analysis was performed to examine the following variables for correlations with changes in weight, height and body mass index percentiles: patient age at surgery, preoperative weight, gender, and ethnic background. SETTING Academic pediatric tertiary medical center. PARTICIPANTS Patients under 2 years of age at the time of surgery, who underwent supraglottoplasty for laryngomalacia, with height and weight measurements recorded within 3 months preceding surgery and greater than 3 months following surgery. INTERVENTION Supraglottoplasty. MAIN OUTCOMES AND MEASURES Change in weight, height and body mass index (BMI) percentile from pre-op to post-op. RESULTS BMI increased from a mean of 15.4 to 18.0 and BMI percentile from a mean of 34 to 51 from pre-op to post-op. The largest BMI percentile increases were observed in infants that were 3 months or younger at the time of surgery, as well as in those under 12 months of age, who were in the lowest BMI quintile. CONCLUSIONS AND RELEVANCE Infants who underwent supraglottoplasty tended to be small in weight and stature, and gained weight after surgery. Most of the weight gain occurred within 6 months of surgery. The largest increases in BMI percentile were observed in infants who were younger and smaller at the time of surgery while the infants older than 18 months had no significant gain.
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Affiliation(s)
- Josephine A Czechowicz
- Department of Otolaryngology - Head and Neck Surgery, Lucile Packard Children's Hospital, Stanford University School of Medicine, 801 Welch Road, Stanford, CA 94305, United States
| | - Kay W Chang
- Department of Otolaryngology - Head and Neck Surgery, Lucile Packard Children's Hospital, Stanford University School of Medicine, 801 Welch Road, Stanford, CA 94305, United States.
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