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Hazkani I, Schniederjan M, Tey CS, Botros AN, Alfonso KP. Neuropathological features of pediatric laryngomalacia. Int J Pediatr Otorhinolaryngol 2024; 182:112012. [PMID: 38861771 DOI: 10.1016/j.ijporl.2024.112012] [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: 05/08/2024] [Revised: 06/01/2024] [Accepted: 06/07/2024] [Indexed: 06/13/2024]
Abstract
OBJECTIVE Laryngomalacia is the most common pediatric laryngeal anomaly. The pathophysiology of laryngomalacia is not well defined; the leading hypothesis suggests weak laryngeal tone and neuromuscular discoordination. Only a few studies explored the histopathology of the laryngeal submucosal nerves, with reported nerve hypertrophy. Our study aims to describe the histopathology of submucosal nerves in specimens obtained from children with severe laryngomalacia compared to pediatric cadaveric controls. STUDY DESIGN Prospective study. SETTINGS Tertiary care children's hospital. METHODS Histologic and immunohistochemical sections of supraglottic tissue from 26 children with severe laryngomalacia and six pediatric autopsies were digitally scanned and assessed with image analysis software (QuPath), resulting in the identification and measurement of 4561 peripheral nerves and over 100,000 foci of neurofilaments. RESULTS Chronic inflammation was noted in all patients. Eosinophils were rare. The mean nerve area and perimeter were significantly smaller for patients with laryngomalacia compared to the control group (1594.0 ± 593.2 μm^2 vs. 2612.1 ± 2824.0 μm^2, p < 0.0001, and 158.8 ± 30.3 μm vs. 217.6 ± 165.0 μm, p < 0.0001). Nerve-per-area unit was significantly greater for patients with laryngomalacia compared to controls (1.39E-05 vs. 6.19 E-06, p = 0.009). The mean area and the number of neurofilaments per total nerve area were similar. Immunohistochemistry for calretinin, a marker for intestinal ganglion cells in Hirschsprung disease, was absent from all specimens. CONCLUSIONS This series includes a comparison of all identifiable nerve fibers obtained from children with severe laryngomalacia and shows that the mucosal nerves are smaller on average than controls. These findings fail to provide support for significant morphologic peripheral nerve pathology in laryngomalacia.
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Affiliation(s)
- Inbal Hazkani
- Division of Pediatric Otolaryngology-Head and Neck Surgery Ann & Robert H. Lurie Children's Hospital of Chicago, The Department of Otolaryngology-Head and Neck Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
| | - Matthew Schniederjan
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Ching Siong Tey
- Division of Pediatric Otolaryngology, Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, GA, USA
| | - Anthony N Botros
- Division of Pediatric Otolaryngology, Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, GA, USA
| | - Kristan P Alfonso
- Division of Pediatric Otolaryngology, Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, GA, USA
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2
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Sanford JN, Lam DJ. Management of Obstructive Sleep Apnea in the Infant and Newborn. Otolaryngol Clin North Am 2024; 57:395-405. [PMID: 38523051 DOI: 10.1016/j.otc.2024.02.006] [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] [Indexed: 03/26/2024]
Abstract
Obstructive sleep apnea in newborns and infants presents a unique challenge with distinct differences in sleep physiology, etiologies, and management compared to older children. The indications for and interpretation of polysomnography are less well defined in infants. There are also no broadly accepted clinical practice guidelines for treating sleep apnea in this age group. Etiologies include general causes of upper airway obstruction in infants such as laryngomalacia, micrognathia, and nasal obstruction in addition to adenotonsillar hypertrophy. Treatment strategies must be tailored to the specific anatomic features and comorbidities of the specific patients and often require a multidisciplinary approach.
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Affiliation(s)
- Jillian N Sanford
- Division of Pediatric Pulmonology and Sleep Medicine, Department of Pediatrics, Oregon Health and Science University, 3181 Southwest Sam Jackson Park Road, Portland, OR 97239, USA
| | - Derek J Lam
- Pediatric Otolaryngology Division, Department of Otolaryngology-Head and Neck Surgery, Oregon Health and Science University, 3181 Southwest Sam Jackson Park Road, Portland, OR 97239, USA.
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3
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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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4
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Mizunoya K, Onodera K, Takahashi Y, Toki T, Saito H, Morimoto Y. Acquired laryngomalacia as a cause of post-extubation stridor and extubation failure following craniotomy: a case report. JA Clin Rep 2023; 9:44. [PMID: 37452981 DOI: 10.1186/s40981-023-00637-5] [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: 05/15/2023] [Revised: 07/06/2023] [Accepted: 07/07/2023] [Indexed: 07/18/2023] Open
Abstract
BACKGROUND Laryngomalacia is a dynamic airway condition characterized by flaccid laryngeal tissue and inward collapse of supraglottic structures during inspiration. Although it may cause airway obstruction and requires careful management, there have been few reports regarding laryngomalacia after surgery. We report a case of adult-onset laryngomalacia occurred after craniotomy requiring reintubation. CASE PRESENTATION A 21-year-old man was admitted to the ICU after craniotomy for a cerebellopontine angle tumor. He developed severe stridor immediately after extubation on the postoperative day 2 and required reintubation. On the postoperative day 5, similar episode occurred following re-extubation and fiberoptic laryngoscopy revealed a collapsed epiglottis and left arytenoid into the glottis. A diagnosis of laryngomalacia was made, and he underwent tracheostomy. Laryngomalacia had completely improved; however, bilateral vocal cord paralysis was detected 2 weeks later. CONCLUSIONS Acquired laryngomalacia should be considered as a possible mechanism of the airway symptoms in a patient with neurological dysfunction.
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Affiliation(s)
- Kazuyuki Mizunoya
- Department of Anesthesiology and Critical Care Medicine, Hokkaido University Hospital, N14W5, Kita-Ku, Sapporo, 060-8648, Japan.
| | - Keisyu Onodera
- Department of Anesthesiology and Critical Care Medicine, Hokkaido University Hospital, N14W5, Kita-Ku, Sapporo, 060-8648, Japan
| | - Yuki Takahashi
- Department of Emergency Medicine, Hokkaido University Hospital, N14W5, Kita-Ku, Sapporo, 060-8648, Japan
| | - Takayuki Toki
- Department of Anesthesiology and Critical Care Medicine, Hokkaido University Hospital, N14W5, Kita-Ku, Sapporo, 060-8648, Japan
| | - Hitoshi Saito
- Department of Anesthesiology and Critical Care Medicine, Hokkaido University Hospital, N14W5, Kita-Ku, Sapporo, 060-8648, Japan
| | - Yuji Morimoto
- Department of Anesthesiology and Critical Care Medicine, Hokkaido University Hospital, N14W5, Kita-Ku, Sapporo, 060-8648, Japan
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5
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Barnicle RN, Bracey A. Uncommon anatomical variation of an epiglottis encountered during emergent endotracheal intubation. J Am Coll Emerg Physicians Open 2022; 3:e12861. [PMID: 36482917 PMCID: PMC9723386 DOI: 10.1002/emp2.12861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Accepted: 11/02/2022] [Indexed: 12/12/2022] Open
Affiliation(s)
- Ryan N. Barnicle
- Department of Emergency MedicineYale University School of MedicineNew HavenConnecticutUSA
| | - Alexander Bracey
- Department of Emergency MedicineAlbany Medical Center, Albany, New York, USA
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6
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Shumrick CM, Calder AN, Vecchiotti MA, Scott AR. Symptomatic Lingual Thyroglossal Duct Cyst in Children: A Laryngomalacia Phenotype. Ann Otol Rhinol Laryngol 2022; 132:95-99. [PMID: 35100842 DOI: 10.1177/00034894221075082] [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: 11/15/2022]
Abstract
OBJECTIVES Patients with lingual thyroglossal duct cyst (TGDC) can present as symptomatic with obstructive airway and feeding difficulties. METHODS We present 3 cases of symptomatic lingual TGDC. RESULTS All 3 patients were diagnosed with laryngomalacia and underwent further concurrent or delayed airway intervention, in addition to cyst removal. CONCLUSIONS We reason that there is a phenotype of laryngomalacia in the symptomatic lingual thyroglossal duct cyst patients who present with symptoms due to disruption in laryngeal anatomy rather than the cyst itself causing obstructive symptoms. Distinguishing this phenotype, especially in comparison to other pathologies such as vallecular cysts, may better allow for planning of concurrent or delayed airway procedures and overall counseling of parents.
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Affiliation(s)
| | - Alyssa N Calder
- Tufts University School of Medicine, Boston, MA, USA.,Drexel University College of Medicine, Philadelphia, PA, USA
| | - Mark A Vecchiotti
- Department of Otolaryngology-Head & Neck Surgery, Tufts Medical Center, Boston, MA, USA.,Tufts University School of Medicine, Boston, MA, USA.,Divisions of Pediatric Otolaryngology and Facial Plastic Surgery, Department of Otolaryngology-Head & Neck Surgery, Tufts Children's Hospital, Boston, MA, USA
| | - Andrew R Scott
- Department of Otolaryngology-Head & Neck Surgery, Tufts Medical Center, Boston, MA, USA.,Tufts University School of Medicine, Boston, MA, USA.,Divisions of Pediatric Otolaryngology and Facial Plastic Surgery, Department of Otolaryngology-Head & Neck Surgery, Tufts Children's Hospital, Boston, MA, USA
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7
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Duncan DR, Larson K, Davidson K, Williams N, Liu E, Watters K, Rahbar R, Rosen RL. Acid Suppression Does Not Improve Laryngomalacia Outcomes but Treatment for Oropharyngeal Dysphagia Might Be Protective. J Pediatr 2021; 238:42-49.e2. [PMID: 34186104 PMCID: PMC9756139 DOI: 10.1016/j.jpeds.2021.06.051] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 05/28/2021] [Accepted: 06/22/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To determine whether the use of acid suppression and thickened feeds impact laryngomalacia outcomes in infants, including supraglottoplasty risk, time to supraglottoplasty, and hospitalization risk. STUDY DESIGN We performed a retrospective cohort study to compare risk and time with supraglottoplasty and frequency and duration of hospitalizations for infants diagnosed with laryngomalacia at Boston Children's Hospital between January 1 and December 31, 2017. The primary outcomes were supraglottoplasty requirement, time to supraglottoplasty, and hospitalization risk. Multivariate analyses were performed to determine predictors of supraglottoplasty and hospitalization risk after adjusting for laryngomalacia severity and comorbidities in addition to propensity score adjustment. Kaplan-Meier curves were created to determine the impact of acid suppression use on time to supraglottoplasty. RESULTS In total, 236 subjects with mean age 62.6 ± 4 days were included in the analysis; 55% were treated with acid suppression. Subjects treated with acid suppression had a greater risk of supraglottoplasty (hazard ratio 3.36, 95% CI 1.36-8.29, P = .009), shorter time to supraglottoplasty (5.64 ± 0.92 vs 7.98 ± 1.92 months, P = .006), and increased respiratory hospitalization risk (relative risk 1.97, 95% CI 1.01-3.85, 0.047), even after adjustment for covariates. Subjects receiving thickening had fewer respiratory hospitalization nights and longer time to supraglottoplasty (9.3 ± 1.7 vs 4.56 ± 0.73 months, P = .004), even after adjustment. CONCLUSIONS Acid suppression use does not reduce the frequency of supraglottoplasty and related hospitalizations compared with untreated subjects. However, patients treated with thickening have decreased hospitalization and longer time to supraglottoplasty, suggesting that thickening of feeds may be a preferred intervention over acid suppression.
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Affiliation(s)
- Daniel R. Duncan
- Aerodigestive Center, Division of Gastroenterology, Hepatology and Nutrition, Boston Children’s Hospital, Boston, Massachusetts
| | - Kara Larson
- Aerodigestive Center, Division of Gastroenterology, Hepatology and Nutrition, Boston Children’s Hospital, Boston, Massachusetts
| | - Kathryn Davidson
- Center for Airway Disorders, Department of Otolaryngology and Communication Enhancement, Boston Children’s Hospital, Boston, MA
| | - Nina Williams
- Aerodigestive Center, Division of Gastroenterology, Hepatology and Nutrition, Boston Children’s Hospital, Boston, Massachusetts
| | - Enju Liu
- Institutional Centers for Clinical and Translational Research, Boston Children’s Hospital, Boston, MA
| | - Karen Watters
- Center for Airway Disorders, Department of Otolaryngology and Communication Enhancement, Boston Children’s Hospital, Boston, MA
| | - Reza Rahbar
- Center for Airway Disorders, Department of Otolaryngology and Communication Enhancement, Boston Children’s Hospital, Boston, MA
| | - Rachel L. Rosen
- Aerodigestive Center, Division of Gastroenterology, Hepatology and Nutrition, Boston Children’s Hospital, Boston, Massachusetts
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8
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Veroul E, Amaddeo A, Leboulanger N, Gelin M, Denoyelle F, Thierry B, Fauroux B, Luscan R. Noninvasive Respiratory Support as an Alternative to Tracheostomy in Severe Laryngomalacia. Laryngoscope 2021; 132:1861-1868. [PMID: 34713900 DOI: 10.1002/lary.29928] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 09/29/2021] [Accepted: 10/19/2021] [Indexed: 11/10/2022]
Abstract
OBJECTIVES/HYPOTHESIS To analyze the role of noninvasive respiratory support (NRS) as an alternative to tracheostomy in the management of severe laryngomalacia. STUDY DESIGN We conducted a monocentric retrospective study in a tertiary pediatric care center. METHODS All children under the age of 3 years with severe laryngomalacia, treated between January 2014 and December 2019, were included. Patient demographics, medical history, nutrition, surgery, NRS, and outcome were reviewed. Predictors for NRS were analyzed. RESULTS One hundred and eighty-eight patients were included. Mean age was 4 ± 5 months and mean weight was 4,925 ± 1,933 g. An endoscopic bilateral supraglottoplasty was performed in 183 (97%) patients and successful in 159 (87%). NRS was initiated in 29 (15%) patients at a mean age of 3 ± 2 months (1-11 months): 15 (52%) patients were treated with NRS after surgical failure, 9 (31%) were treated with NRS initiated prior to surgery because of abnormal overnight gas exchange, and 5 (17%) were treated exclusively with NRS due to comorbidities contraindicating an endoscopic procedure. NRS was successfully performed in all patients with a mean duration of 6 ± 11 months. No patient required a tracheostomy. Univariate analysis identified the following predictors of NRS: neonatal respiratory distress (P = .003), neurological comorbidity (P < .001), associated laryngeal abnormality (P < .001), cardiac surgery (P = .039), surgical endoscopic revision (P = .007), and nutritional support (P < .001). CONCLUSION NRS is a safe procedure, which may avoid a tracheostomy in severe laryngomalacia, in particular, in case of endoscopic surgery failure, respiratory failure before surgery, and/or severe co-morbidity. LEVEL OF EVIDENCE 3 Laryngoscope, 2021.
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Affiliation(s)
- Elina Veroul
- Faculté de Médecine, Université de Paris, Paris, France.,Department of Pediatric Otolaryngology, AP-HP, Hôpital Necker - Enfants Malades, Paris, France
| | - Alessandro Amaddeo
- Faculté de Médecine, Université de Paris, Paris, France.,Pediatric Noninvasive Ventilation and Sleep Unit, AP-HP, Hôpital Necker - Enfants Malades, Paris, France
| | - Nicolas Leboulanger
- Faculté de Médecine, Université de Paris, Paris, France.,Department of Pediatric Otolaryngology, AP-HP, Hôpital Necker - Enfants Malades, Paris, France.,Institut Mondor pour la Recherche Biomédicale, INSERM U955 Team 13, Creteil, France
| | - Matthieu Gelin
- Université de Paris, Human Immunology Pathophysiology Immunotherapy (HIPI), CytoMorpho Lab, INSERM CEA UMR976, Paris, France
| | - Françoise Denoyelle
- Faculté de Médecine, Université de Paris, Paris, France.,Department of Pediatric Otolaryngology, AP-HP, Hôpital Necker - Enfants Malades, Paris, France
| | - Briac Thierry
- Faculté de Médecine, Université de Paris, Paris, France.,Department of Pediatric Otolaryngology, AP-HP, Hôpital Necker - Enfants Malades, Paris, France
| | - Brigitte Fauroux
- Faculté de Médecine, Université de Paris, Paris, France.,EA 7330 VIFASOM (Vigilance Fatigue Sommeil et Santé Publique), Université de Paris, Paris, France
| | - Romain Luscan
- Faculté de Médecine, Université de Paris, Paris, France.,Department of Pediatric Otolaryngology, AP-HP, Hôpital Necker - Enfants Malades, Paris, France
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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: 6] [Impact Index Per Article: 2.0] [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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10
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Abstract
Laryngomalacia is the most common cause of stridor in newborns. Affected patients may present with noisy breathing, a classic high-pitched inspiratory stridor that worsens with feeding. While the exact etiology remains unclear, the condition is characterized by softening of the supraglottic structures, including the epiglottis, aryepiglottic folds, and arytenoid cartilages. The condition is most often self-limited and requires expectant management. However, in some infants, severe disease, including failure to thrive or respiratory distress, may require medical or even surgical intervention. When caring for premature neonates, special care is required to evaluate for synchronous airway lesions.
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Affiliation(s)
- James A Leonard
- Department of Otolaryngology, MedStar Georgetown University Hospital, Washington, DC
| | - Brian K Reilly
- Division of Pediatric Otolaryngology, Children's National Medical Center, Washington, DC
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11
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Risk factors for peri-operative respiratory adverse events after supraglottoplasty. Int J Pediatr Otorhinolaryngol 2021; 149:110853. [PMID: 34364176 DOI: 10.1016/j.ijporl.2021.110853] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 06/21/2021] [Accepted: 07/22/2021] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To determine demographic and peri-operative characteristics that predict peri-operative respiratory adverse events (PRAE) requiring intensive care unit (ICU) level intervention after supraglottoplasty. STUDY DESIGN Case series with chart review. SETTING Tertiary care children's hospital. METHODS Retrospective chart review was conducted of children with laryngomalacia who underwent supraglottoplasty between October 2014 and November 2019. PRAE were defined as any of the following events or requirements within 24 h of surgery: 1) failure to extubate, 2) reintubation, 3) positive pressure ventilation, 4) more than one dose of racemic epinephrine, or 5) greater than 4 L of oxygen via nasal cannula. RESULTS Fifty-one subjects were enrolled, with a median age of 4.8 months and majority (62 %) Hispanic. Twenty-one (41 %) subjects experienced PRAE. After adjusting for age and gender on multivariate analysis, children admitted preoperatively to the ICU were more likely to have PRAE than those not admitted or admitted to a floor unit (OR 40.1, 95%CI: 4.1-388.6, p = 0.001). Additionally, children with intraoperative oxygen desaturations below 90 % for greater than 1 min were more likely to have PRAE than those who did not (OR 21.3, 95%CI: 2.4-189.9, p = 0.006). Other factors significantly associated with PRAE on univariate analysis included chronic lung disease, congenital cardiac abnormality, history of intubation, supplemental oxygen requirement, gastrostomy tube dependence, intraoperative intubation and longer surgery length. CONCLUSION Preoperative ICU admission and intraoperative oxygen desaturations are independent risk factors for PRAE after supraglottoplasty. Results from this study can help inform decisions regarding the appropriate level of postoperative care required after supraglottoplasty. LEVEL OF EVIDENCE IV.
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12
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Handling and progress until achieved oral ingestion against dysphagia of congenital pseudobulbar palsy. PEDIATRIC DENTAL JOURNAL 2021. [DOI: 10.1016/j.pdj.2021.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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13
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Nguyen M, Brooks L, Wetzel M, Raol N. Swallowing Outcomes Following Supraglottoplasty: A Retrospective Review. Laryngoscope 2021; 131:2817-2822. [PMID: 34228358 DOI: 10.1002/lary.29704] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 05/20/2021] [Accepted: 06/17/2021] [Indexed: 11/08/2022]
Abstract
OBJECTIVES/HYPOTHESIS Determine the incidence of short- and long-term dysphagia in pediatric patients with and without syndromes/neurodevelopmental delay following supraglottoplasty (SGP) at our institution. STUDY DESIGN Retrospective cohort study. METHODS A retrospective cohort study of children ≤18 years old who underwent SGP from 2014 to 2019 was undertaken. Age at surgery, sex, race, insurance, underlying syndromes/neurodevelopmental delay, concurrent surgical procedures, and clinical swallowing assessments were reviewed. Logistic regression was performed to identify factors associated with postoperative feeding difficulties. Time-to-event analysis was performed to assess time to resolution of dysphagia. RESULTS A total of 231 patients were identified. Average age at time of SGP was 13.7 months. Of 231 patients, 88 (38.1%) had a syndrome/neurodevelopmental delay. Of these 231 patients, 112 had a preoperative videofluoroscopic swallow study or fiberoptic endoscopic evaluation of swallowing, of whom 53/112 (47.3%) had dysphagia. After SGP, 138/231 (59.7%) underwent clinical/instrumental swallowing assessments, of whom 95/138 (68.8%) had immediate postsurgical dysphagia. At last follow-up (1 month to 45 months), 15/95 (15.8%) had persistent dysphagia on instrumental assessment, 14/15 of whom had syndromes/neurodevelopmental delay. Time-to-event analysis revealed that for the nonsyndromic cohort, 25% had resolution of dysphagia by 4 months, 50% by 10 months, and 75% by 14 months. Cox proportional hazards regression revealed that the presence of underlying syndromes/neurodevelopmental delay was the only factor predictive of long-term postoperative dysphagia (hazard ratio of resolution 0.21 [95% confidence interval 0.096-0.48]). CONCLUSIONS While short-term feeding difficulties following SGP in pediatric patients are not uncommon, long-term dysphagia is rare in patients without syndromes/neurodevelopmental delay. These data can be used when counseling caregivers about the risks and benefits of SGP. LEVEL OF EVIDENCE 4 Laryngoscope, 2021.
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Affiliation(s)
- Mai Nguyen
- Department of Otolaryngology-Head and Neck Surgery, Emory University School of Medicine, Atlanta, Georgia, U.S.A
| | - Laura Brooks
- Department of Rehabilitation Services, Children's Healthcare of Atlanta, Atlanta, Georgia, U.S.A
| | - Martha Wetzel
- Division of Biostatistics, Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, U.S.A
| | - Nikhila Raol
- Department of Otolaryngology-Head and Neck Surgery, Emory University School of Medicine, Atlanta, Georgia, U.S.A.,Division of Pediatric Otolaryngology, Children's Healthcare of Atlanta, Atlanta, Georgia, U.S.A
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Abo Elmagd E, El Hawary B, Hassan MM, Kassem H, El Tahan AER. Etiological profile of upper airway obstruction in infants. THE EGYPTIAN JOURNAL OF OTOLARYNGOLOGY 2020; 36:36. [DOI: 10.1186/s43163-020-00034-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Accepted: 08/25/2020] [Indexed: 09/02/2023]
Abstract
AbstractBackgroundRespiratory distress is recognized as any sign of breathing difficulty in infants. Some congenital anomalies present immediately with airway distress, while others are asymptomatic or discovered later in infancy or childhood. Our objectives are to detect different laryngeal causes of respiratory distress in infants and to measure the relative risk of some variables like age, sex, family history, and other congenital anomalies for developing laryngeal causes of respiratory distress. This observational cross-sectional study was carried out during the period from June 2017 to December 2018 at Children’s University Hospital. The study included 80 infants who presented with respiratory distress and admitted to the hospital. All patients subjected to a detailed history from their parents and full general and ENT examinations. X-ray, MSCT neck or direct laryngoscope were carried out in selected cases.ResultsAs regard age, 58% of cases were between 1–6 months, 28% of cases between 6 months and 1 year, and 14% between 1–2 years. Laryngeal causes of respiratory distress among infants were distributed as follow: 70% laryngomalacia, 18% subglottic stenosis, 8% laryngeal web, and 4% of cases were caused by vocal fold paralysis (VFP). The laryngeal causes of respiratory distress did not reveal any statistically significant difference among different age groups or between both genders (P = 0.257, 0.286; respectively). Also, there was no statistically significant difference between infants with positive family history and those without as regard the laryngeal causes of respiratory distress (P = .378).ConclusionThe majority of respiratory distress cases (58%) were between 1–6 months. Bivariant analysis of variables age, sex, family history, and other congenital anomalies showed that they were not potent risk factors for developing laryngomalacia, subglottic stenosis, laryngeal web, and vocal fold paralysis. Laryngomalacia represented the commonest cause of respiratory distress (70%) followed by subglottic stenosis (18%), then laryngeal web (8%), and finally the vocal fold paralysis represented the least percentage (4%). Apart from laryngomalacia, the percentages of other causes seem to vary according to sample size and geographic area of study. So, being familiar with the common causes of respiratory distress in a given region is very essential in order not to miss a potentially life-threatening diagnosis.
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15
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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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16
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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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Irace AL, Dombrowski ND, Kawai K, Watters K, Choi S, Perez J, Dodrill P, Hernandez K, Davidson K, Rahbar R. Evaluation of Aspiration in Infants With Laryngomalacia and Recurrent Respiratory and Feeding Difficulties. JAMA Otolaryngol Head Neck Surg 2020; 145:146-151. [PMID: 30589926 DOI: 10.1001/jamaoto.2018.3642] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Laryngomalacia is the most common laryngeal anomaly and is commonly associated with stridor in children, but the recurrent respiratory and/or feeding difficulties associated with this condition may pose a threat to the well-being of the affected child. Objective To describe the prevalence of aspiration in pediatric patients with laryngomalacia who present with recurrent respiratory issues and/or feeding difficulty. Design, Setting, and Participants This retrospective review of medical records involved 142 pediatric patients. These patients received a laryngomalacia diagnosis, presented with recurrent respiratory and/or feeding difficulties, and underwent a modified barium swallow (MBS) study at a tertiary referral children's hospital from January 1, 2015, to December 31, 2015. Each patient was assessed for aspiration and swallowing discoordination. Data collection and analysis were performed from December 1, 2016, to September 30, 2017. Main Outcomes and Measures Demographic data, presenting symptoms, medical comorbidities, and feeding and dysphagia details were collected and analyzed. Speech-language pathologists reviewed all MBS reports to identify the presence and type of aspiration (ie, silent vs nonsilent) with different textures and consistencies of food and liquid. Results A total of 395 patients were diagnosed with laryngomalacia in 2015. One hundred forty-two of these patients (35.9%) presented with recurrent respiratory issues and/or feeding difficulties and were referred for MBS study for further evaluation. Ninety-two (64.8%) were male, with a median (interquartile range) age at the time of MBS study of 7.9 (3.2-20.5) months. Among these patients, 128 (90.1%) had swallowing dysfunction documented during the MBS study. Aspiration was identified in 60 patients (42.3%), and silent aspiration was documented in 59 (98.3%) of these 60 patients. Epilepsy or seizures (risk difference [RD], 11%; 95% CI, 5%-17%), laryngeal cleft (RD, 8%; 95% CI, 3%-13%), and premature birth (RD, 15%; 95% CI, 5%-25%) were statistically significantly associated with abnormal MBS findings. Conclusions and Relevance Swallowing dysfunction and aspiration were commonly found in pediatric patients with laryngomalacia and recurrent feeding and/or respiratory issues; these children should undergo an MBS study for dysphagia and silent aspiration.
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Affiliation(s)
- Alexandria L Irace
- Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, Boston, Massachusetts
| | - Natasha D Dombrowski
- Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, Boston, Massachusetts
| | - Kosuke Kawai
- Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, Boston, Massachusetts.,Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts
| | - Karen Watters
- Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, Boston, Massachusetts.,Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts
| | - Sukgi Choi
- Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, Boston, Massachusetts.,Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts
| | - Jennifer Perez
- Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, Boston, Massachusetts
| | - Pamela Dodrill
- Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, Boston, Massachusetts
| | - Kayla Hernandez
- Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, Boston, Massachusetts
| | - Kathryn Davidson
- Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, Boston, Massachusetts
| | - Reza Rahbar
- Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, Boston, Massachusetts.,Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts
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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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19
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Friedman S, Sadot E, Gut G, Armoni Domany K, Sivan Y. Laryngeal ultrasound for the diagnosis of laryngomalacia in infants. Pediatr Pulmonol 2018; 53:772-777. [PMID: 29405660 DOI: 10.1002/ppul.23964] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2017] [Accepted: 01/16/2018] [Indexed: 11/05/2022]
Abstract
INTRODUCTION Laryngomalacia is the most prevalent cause of congenital stridor. Flexible laryngobronchoscopy (FLB) is the gold standard for diagnosis. However, FLB requires venous access, deep sedation or general anesthesia, and is associated with patient's and parental discomfort and a considerable cost. Laryngeal ultrasound (LUS) has been shown to provide good evaluation of the normal anatomy and the dynamic motion of laryngeal structures. We investigated the yield of LUS in the diagnosis of laryngomalacia in infants with congenital stridor compared to FLB. METHODS A prospective blind study of consecutive infants referred for FLB due to congenital stridor with unknown cause. The presence of arytenoids adduction on LUS during inspiration was used to diagnose laryngomalacia. LUS was followed by FLB under anesthesia. The physician performing the FLB was blinded to the LUS results. RESULTS Twenty-four patients participated in the study (54% males). Median (IQR) age and weight were 3.5 (1-7.7) months and 5.1 (4-8.4) kg, respectively. LUS was well tolerated in all infants. Compared to FLB, LUS correctly diagnosed laryngomalacia in 11/14 (78.6%) infants. In 10 infants FLB ruled out laryngomalacia of whom LUS concurred in 9 infants and one was falsely diagnosed with laryngomalacia. LUS had a sensitivity of 78.5% (CI 52-95%), specificity of 90% (CI 49-94%), NPV of 75%, and PPV of 92%. ROC analysis demonstrated AUC of 0.84 (P < 0.01, 95%CI: 0.67-1.0). CONCLUSION We suggest that LUS has a role in screening congenital stridor in otherwise healthy infants when laryngomalacia is highly probable.
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Affiliation(s)
- Shirley Friedman
- Division of Pediatric Pulmonology, Critical Care and Sleep Medicine, "Dana-Dwek" Children's Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv University Sackler Faculty of Medicine, Tel Aviv, Israel
| | - Efraim Sadot
- Division of Pediatric Pulmonology, Critical Care and Sleep Medicine, "Dana-Dwek" Children's Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv University Sackler Faculty of Medicine, Tel Aviv, Israel
| | - Guy Gut
- Division of Pediatric Pulmonology, Critical Care and Sleep Medicine, "Dana-Dwek" Children's Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv University Sackler Faculty of Medicine, Tel Aviv, Israel
| | - Keren Armoni Domany
- Division of Pediatric Pulmonology, Critical Care and Sleep Medicine, "Dana-Dwek" Children's Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv University Sackler Faculty of Medicine, Tel Aviv, Israel
| | - Yakov Sivan
- Division of Pediatric Pulmonology, Critical Care and Sleep Medicine, "Dana-Dwek" Children's Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv University Sackler Faculty of Medicine, Tel Aviv, Israel
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20
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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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Cronjé L. Bardet–Biedl syndrome: expect the unexpected, suspect the unsuspected. SOUTHERN AFRICAN JOURNAL OF ANAESTHESIA AND ANALGESIA 2017. [DOI: 10.1080/22201181.2017.1379719] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
- Larissa Cronjé
- Perioperative Research Group, Department of Anaesthesiology and Critical Care, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, King Edward VIII Hospital, Durban, South Africa
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Julien-Marsollier F, Salis P, Abdat R, Diallo T, Van Den Abbelle T, Dahmani S. Predictive factors of early postoperative respiratory complications after tonsillectomy in children with unidentified risks for this complication. Anaesth Crit Care Pain Med 2017; 37:439-445. [PMID: 29033358 DOI: 10.1016/j.accpm.2017.09.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2017] [Revised: 06/15/2017] [Accepted: 09/03/2017] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Tonsillectomy is considered as a therapeutic option in obstructive sleep apnoea syndrome (OSAS). Postoperative respiratory failure is a complication that can require respiratory support. The main objective of our study is to determine risk factors of postoperative respiratory complications in children undergoing tonsillectomy. MATERIAL AND METHODS This is a retrospective single centre observational study including patients with unanticipated postoperative respiratory failure. Patients with a planned preoperative intensive care admission were excluded (age is lower than 2 years, overweight (>95% percentile of BMI), moderate or severe asthma, major medical conditions). Those patients were compared with randomly selected control patients. Factors studied were: age, weight, indication of surgery, ASA status, preoperative illness conditions, durations of surgery and anaesthesia and administered medications. Statistics used a univariate analysis and a multivariate logistic regression. RESULTS Eight hundred and five patients underwent adenotonsillectomy during the study period and 25 developed postoperative respiratory failure. These patients were compared to 103 non-complicated control patients. Age (<4 years), weight (<18kg), indication of surgery (as SOAS), laryngomalacia, stable and minor congenital cardiac malformation and duration of anaesthesia were found statistically associated. Multivariate analysis found that weight <18kg is a risk factor associated with the occurrence of postoperative respiratory failure. Overall the model shows a strong accuracy with an area under the curve of ROC analysis of 0.9 [95% confidence interval: 0.85-0.95]. DISCUSSION Our study found that weight <18kg is a major risk factor for predicting a postoperative respiratory complication.
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Affiliation(s)
- Florence Julien-Marsollier
- Department of Anaesthesia, Intensive care and Pain Management, Robert Debré University Hospital, AP-HP, 48, boulevard Sérurier, 75019 Paris, France; Paris Diderot University (Paris 7), Pres Paris Sorbonne Cité, 75000 Paris, France
| | - Pierre Salis
- Department of Anaesthesia, Intensive care and Pain Management, Robert Debré University Hospital, AP-HP, 48, boulevard Sérurier, 75019 Paris, France; Paris Diderot University (Paris 7), Pres Paris Sorbonne Cité, 75000 Paris, France
| | - Rachida Abdat
- Department of Anaesthesia, Intensive care and Pain Management, Robert Debré University Hospital, AP-HP, 48, boulevard Sérurier, 75019 Paris, France; Paris Diderot University (Paris 7), Pres Paris Sorbonne Cité, 75000 Paris, France
| | - Thierno Diallo
- Department of Anaesthesia, Intensive care and Pain Management, Robert Debré University Hospital, AP-HP, 48, boulevard Sérurier, 75019 Paris, France; Paris Diderot University (Paris 7), Pres Paris Sorbonne Cité, 75000 Paris, France
| | - Thierry Van Den Abbelle
- Paris Diderot University (Paris 7), Pres Paris Sorbonne Cité, 75000 Paris, France; Department of Ent-Nose and Throat Surgery, Robert Debré University Hospital, AP-HP, 75019 Paris, France; UMR Inserm U 676, Robert Debré University Hospital, 75019 Paris, France
| | - Souhayl Dahmani
- Department of Anaesthesia, Intensive care and Pain Management, Robert Debré University Hospital, AP-HP, 48, boulevard Sérurier, 75019 Paris, France; Paris Diderot University (Paris 7), Pres Paris Sorbonne Cité, 75000 Paris, France; Department of Ent-Nose and Throat Surgery, Robert Debré University Hospital, AP-HP, 75019 Paris, France.
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Topical Lidocaine Does Not Exaggerate Laryngomalacia in Infants During Flexible Bronchoscopy Under Propofol Anesthesia. J Bronchology Interv Pulmonol 2017; 23:215-9. [PMID: 27261936 DOI: 10.1097/lbr.0000000000000291] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Topical lidocaine has been found to result in overestimation of the severity of laryngomalacia in infants undergoing flexible bronchoscopy under conscious sedation with midazolam and nalbuphine. This effect has never been confirmed and may depend on the level of sedation and the drugs used. We assessed the effect of topical lidocaine on laryngomalacia in infants undergoing flexible bronchoscopy under general anesthesia with propofol. METHODS Thirteen infants with congenital stridor referred to diagnostic flexible video-bronchoscopy were studied under propofol anesthesia before and 3 minutes after topical lidocaine administration to the larynx at a dose of 3 mg/kg body weight. Laryngomalacia was scored using 60 seconds video recordings of the larynx before and after lidocaine administration in random order by 2 independent blinded observers using the previously described arytenoid score (AS), epiglottis score (ES), and the total score (TS=AS+ES). RESULTS No significant differences in AS, ES, and laryngomalacia score were found between the prelidocaine and postlidocaine assessments by the 2 raters. The intraclass correlation coefficients were 0.995 (95% confidence interval, 0.986-0.998) and 0.975 (0.930-0.991) and 0.989 (0.971-996) for AS, ES, and TS, respectively. CONCLUSIONS The assessment of laryngomalacia is not affected by topical lidocaine under propofol anesthesia. The lidocaine effect on laryngomalacia may vary depending on the medication regime used and the depth of procedural sedation.
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LaMantia AS, Moody SA, Maynard TM, Karpinski BA, Zohn IE, Mendelowitz D, Lee NH, Popratiloff A. Hard to swallow: Developmental biological insights into pediatric dysphagia. Dev Biol 2015; 409:329-42. [PMID: 26554723 DOI: 10.1016/j.ydbio.2015.09.024] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2015] [Revised: 09/10/2015] [Accepted: 09/15/2015] [Indexed: 12/16/2022]
Abstract
Pediatric dysphagia-feeding and swallowing difficulties that begin at birth, last throughout childhood, and continue into maturity--is one of the most common, least understood complications in children with developmental disorders. We argue that a major cause of pediatric dysphagia is altered hindbrain patterning during pre-natal development. Such changes can compromise craniofacial structures including oropharyngeal muscles and skeletal elements as well as motor and sensory circuits necessary for normal feeding and swallowing. Animal models of developmental disorders that include pediatric dysphagia in their phenotypic spectrum can provide mechanistic insight into pathogenesis of feeding and swallowing difficulties. A fairly common human genetic developmental disorder, DiGeorge/22q11.2 Deletion Syndrome (22q11DS) includes a substantial incidence of pediatric dysphagia in its phenotypic spectrum. Infant mice carrying a parallel deletion to 22q11DS patients have feeding and swallowing difficulties that approximate those seen in pediatric dysphagia. Altered hindbrain patterning, craniofacial malformations, and changes in cranial nerve growth prefigure these difficulties. Thus, in addition to craniofacial and pharyngeal anomalies that arise independently of altered neural development, pediatric dysphagia may result from disrupted hindbrain patterning and its impact on peripheral and central neural circuit development critical for feeding and swallowing. The mechanisms that disrupt hindbrain patterning and circuitry may provide a foundation to develop novel therapeutic approaches for improved clinical management of pediatric dysphagia.
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Affiliation(s)
- Anthony-Samuel LaMantia
- Institute for Neuroscience, The George Washington University School of Medicine and Health Sciences, Washington D.C., USA; Department of Pharmacology and Physiology, George Washington University, School of Medicine and Health Sciences, Washington D.C., USA
| | - Sally A Moody
- Institute for Neuroscience, The George Washington University School of Medicine and Health Sciences, Washington D.C., USA; Department of Anatomy and Regenerative Biology, George Washington University, School of Medicine and Health Sciences, Washington D.C., USA
| | - Thomas M Maynard
- Institute for Neuroscience, The George Washington University School of Medicine and Health Sciences, Washington D.C., USA; Department of Pharmacology and Physiology, George Washington University, School of Medicine and Health Sciences, Washington D.C., USA
| | - Beverly A Karpinski
- Institute for Neuroscience, The George Washington University School of Medicine and Health Sciences, Washington D.C., USA; Department of Pharmacology and Physiology, George Washington University, School of Medicine and Health Sciences, Washington D.C., USA
| | - Irene E Zohn
- Institute for Neuroscience, The George Washington University School of Medicine and Health Sciences, Washington D.C., USA; Center for Neuroscience Research, Children's National Health System, Washington D.C., USA
| | - David Mendelowitz
- Institute for Neuroscience, The George Washington University School of Medicine and Health Sciences, Washington D.C., USA; Department of Pharmacology and Physiology, George Washington University, School of Medicine and Health Sciences, Washington D.C., USA
| | - Norman H Lee
- Institute for Neuroscience, The George Washington University School of Medicine and Health Sciences, Washington D.C., USA; Department of Pharmacology and Physiology, George Washington University, School of Medicine and Health Sciences, Washington D.C., USA
| | - Anastas Popratiloff
- Institute for Neuroscience, The George Washington University School of Medicine and Health Sciences, Washington D.C., USA; Department of Anatomy and Regenerative Biology, George Washington University, School of Medicine and Health Sciences, Washington D.C., USA
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25
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Karande S, Divecha C, Dias R, Deshmukh CT. Rare treatment option for a common pediatric airway problem. Indian J Crit Care Med 2015; 19:681-3. [PMID: 26730122 PMCID: PMC4687180 DOI: 10.4103/0972-5229.169355] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Laryngomalacia is a common cause of respiratory obstruction with stridor in infants. Although most cases resolve spontaneously, severe laryngomalacia needs surgical intervention. Tracheostomies have been the mainstay of treatment. However, this procedure was associated with high morbidity. At present, newer modalities of treatment are being tried. We discuss successful management of an infant having severe laryngomalacia (who had three failed extubation trials) with glossoepiglottopexy.
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26
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Galluzzi F, Schindler A, Gaini RM, Garavello W. The assessment of children with suspected laryngopharyngeal reflux: An Otorhinolaringological perspective. Int J Pediatr Otorhinolaryngol 2015; 79:1613-9. [PMID: 26279249 DOI: 10.1016/j.ijporl.2015.07.037] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2015] [Revised: 07/26/2015] [Accepted: 07/27/2015] [Indexed: 12/24/2022]
Abstract
The assessment of pediatric laryngopharyngeal reflux (LPR) is controversial. Otorhinolaryngologists may play a role in the evaluation of children with suspected LPR detecting typical airway endoscopic findings and/or associated diseases and may help in the selection of children to be subjected to further instrumental tests. In this perspective the present review aims at examining the available evidence in the literature regarding the assessment of LPR in children. After careful literature search there are no current validated symptoms assessment questionnaires for LPR evaluation in children; flexible fiberoptic nasopharyngolaryngoscopy remains controversial as a diagnostic tool in suspect LPR cases; even though the multichannel intraluminal impedance with pH monitoring has been proposed as the instrumental gold standard, further evidence need to be found for validation in children with typical features of LPR.
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Affiliation(s)
| | - Antonio Schindler
- Phoniatric Unit, Department of Biomedical and Clinical Sciences "L. Sacco," University of Milan, Milan, Italy
| | - Renato Maria Gaini
- Department of Otorhinolaryngology, San Gerardo Hospital, Monza, Italy; Department of Surgery and Translational Medicine, University of Milano-Bicocca, Milan, Italy
| | - Werner Garavello
- Department of Otorhinolaryngology, San Gerardo Hospital, Monza, Italy; Department of Surgery and Translational Medicine, University of Milano-Bicocca, Milan, Italy
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27
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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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28
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Thottam PJ, Simons JP, Choi S, Maguire R, Mehta DK. Clinical relevance of quality of life in laryngomalacia. Laryngoscope 2015; 126:1232-5. [DOI: 10.1002/lary.25491] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2015] [Revised: 05/14/2015] [Accepted: 06/12/2015] [Indexed: 11/07/2022]
Affiliation(s)
- Prasad John Thottam
- Department of Pediatric Otolaryngology; Children's Hospital of Pittsburgh; Pittsburgh Pennsylvania U.S.A
| | - Jeffrey P. Simons
- Department of Pediatric Otolaryngology; Children's Hospital of Pittsburgh; Pittsburgh Pennsylvania U.S.A
| | - Sukgi Choi
- Department of Pediatric Otolaryngology; Children's Hospital of Pittsburgh; Pittsburgh Pennsylvania U.S.A
| | - Raymond Maguire
- Department of Pediatric Otolaryngology; Children's Hospital of Pittsburgh; Pittsburgh Pennsylvania U.S.A
| | - Deepak K. Mehta
- Department of Pediatric Otolaryngology; Children's Hospital of Pittsburgh; Pittsburgh Pennsylvania U.S.A
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29
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Setabutr D, Perez MR, Truong MT, Senders CW, Rubinstein BK. Neurofibromatosis of the larynx causing stridor and sleep apnea. Am J Otolaryngol 2014; 35:631-5. [PMID: 24888794 DOI: 10.1016/j.amjoto.2014.04.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2014] [Accepted: 04/26/2014] [Indexed: 11/16/2022]
Abstract
BACKGROUND Neurofibromatosis type 1 can rarely present in the larynx. Patients typically do not present with complete obstructive symptoms, but partial obstruction and stridor. We review our health centers' case series of two patients, the first of whom presented with persistent sleep apnea post tonsillectomy and adenoidectomy, and the second who presented with noisy breathing. Additionally, we will review the literature on the management and treatment options for children with this rare clinical entity. METHODS Retrospective case review. CASE REPORT & RESULTS A two-year old male underwent a sleep endoscopy following persistent evidence of obstructive sleep apnea on polysomnography after initial tonsillectomy and adenoidectomy. Family elicited concerns about noisy breathing at night and an accompanying video documented stridor while sleeping during the monitored polysomnography. Flexible fiberoptic laryngoscopy in the operating room revealed what appeared to be a cystic mass along the right aryepiglottic fold causing deviation of the laryngeal introitus towards the contralateral side. Subsequent direct laryngoscopy and excisional biopsy revealed pathology results consistent with a plexiform neurofibroma. A six-month-old patient with stertor and stridor was found to have a laryngeal mass, subglottic stensosis, and progressive airway obstruction due to plexiform neurofirboma in the supraglottis, subglottis, and trachea. We present a series of two patients incidentally diagnosed with neurofibromatosis type 1 by way of a laryngeal neurofibroma and review the literature on management options. Both patients were found to have accompanying café au lait spots. Both patients required tracheostomy for airway management, and one was successfully decannulated. CONCLUSION Laryngeal neurofibroma is a rare anomaly that can manifest with airway obstruction. Both patients presented here subsequently were noted to have café au lait spots on physical examination. The Otolaryngologist should be reminded of this anomaly when evaluating a child with evidence of a submucosal laryngeal mass. We present our series including that of a patient whose diagnosis was prompted by persistent sleep apnea following adenotonsillectomy tonsillectomy and a patient with airway obstruction and subglottic stenosis due to a neurofibroma. The treatment of choice is complete excision of the neurofibroma while maintaining functionality of the larynx. This can lead to successful decannulation.
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Affiliation(s)
- Dhave Setabutr
- Department of Otolaryngology, UC Davis Medical Center, Sacramento, CA USA.
| | - Myrza R Perez
- Division of Pediatric Pulmonology, Kaiser Permanente, Roseville, CA USA
| | - Mai Thy Truong
- Department of Head & Neck Surgery, Kaiser Permanente, Santa Clara, CA USA
| | - Craig W Senders
- Department of Otolaryngology, UC Davis Medical Center, Sacramento, CA USA
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30
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Risk factors for failure of supraglottoplasty. Int J Pediatr Otorhinolaryngol 2014; 78:1485-8. [PMID: 25005226 DOI: 10.1016/j.ijporl.2014.06.014] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2014] [Revised: 06/07/2014] [Accepted: 06/11/2014] [Indexed: 11/20/2022]
Abstract
OBJECTIVES To assess for identifiable risk factors for failed surgical intervention in children with laryngomalacia. METHODS Retrospective case note review between September 2007 and March 2012. Case notes were reviewed for demographic data, symptoms, co-morbidities, operative technique, postoperative recovery, complications, length of hospital stay including intensive care unit (ICU) care, and resolution of symptoms. RESULTS 148 children underwent supraglottoplasty. Case notes were available for 115 (78%) patients. 35% (41/115) of cases were females and 65% (74/115) were male. A bimodal age distribution was observed with peaks at 3 months and 3.5 years. Those over one year of age were more likely to have complications (p = 0.035). There was no significant difference in outcomes for age (p > 0.05). In patients less than one year, reflux symptoms were significantly associated with a higher likelihood of failure of the operation (p = 0.013). Patients under one year with pre-operatively identified comorbid conditions were less likely to have an improvement in breathing (p = 0.002). Cold steel was used in 55% (63/115) of cases, laser only in 17% (20/115) cases and a combination of the two techniques in 28%, (32/115). There was no association between the surgical technique used and complications (p = 0.558). There was no association between improvement in symptoms and surgical technique used (p = 0.560). There was a significant association between delayed post-operative neurological diagnosis and failure of the operation (p < 0.001). 21 (18%) patients required a second procedure. CONCLUSIONS Pre-operative predictors of failure were patients with reflux symptoms (p = 0.013). Patients that required a second procedure were 37 times more likely to have a delayed diagnosis of an underlying neurological condition. Failure of symptoms to improve after supraglottoplasty should alert the clinician to the possibility of an underlying neurological disorder.
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