1
|
Hashish ME, Salem MA, El-Degwi MA, Alsobky ME, Wahba BA, El-Deeb ME, Negm A, ElSobki A. Does surgery affect the neurodevelopmental outcome of moderate laryngomalacia? Int J Pediatr Otorhinolaryngol 2024; 182:112013. [PMID: 38908258 DOI: 10.1016/j.ijporl.2024.112013] [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: 04/25/2024] [Revised: 05/25/2024] [Accepted: 06/07/2024] [Indexed: 06/24/2024]
Abstract
BACKGROUND Moderate laryngomalacia lies in the grey zone where the parents and treating team might hesitate to decide the treatment plan for the child. Neurodevelopmental assessment of the child was neither assessed nor incorporated in surgical decision-making in the past. OBJECTIVES To evaluate the neurodevelopmental outcome of moderate laryngomalacia treatment strategies (surgery versus conservative). METHODS We conducted an observational multicentric cohort study. We compared two groups of patients according to their moderate laryngomalacia treatment strategy: surgical treatment and no treatment. The neurodevelopmental outcome was assessed by Griffiths-III developmental scales. RESULTS A total of 150 children were diagnosed with moderate laryngomalacia of which 56 were successfully treated with surgery and 94 improved without intervention. The median Griffiths-III developmental quotients (DQs) of subscales A, B, C, E, and general development were significantly higher in the surgically treated group compared to conservatively treated ones. CONCLUSION Untreated moderate laryngomalacia cases have worse neurodevelopmental outcomes than surgically treated cases.
Collapse
Affiliation(s)
| | | | | | | | | | - Mohamed E El-Deeb
- Faculty of Medicine, Kafr Elsheikh University, Kafr Elsheikh, Egypt.
| | - Ahmed Negm
- Faculty of Medicine, Misr University for Science and Technology, Cairo, Egypt
| | - Ahmed ElSobki
- Faculty of Medicine, Mansoura University, Mansoura, Egypt
| |
Collapse
|
2
|
Casellas NJ, Shah S, Ravikumar S, Vandjelovic ND, Faria J, Allen PD, McKenna Benoit MK. Polysomnogram outcomes in patients with laryngomalacia and obstructive sleep apnoea treated surgically versus non-surgically. J Laryngol Otol 2024; 138:436-442. [PMID: 37212024 PMCID: PMC10950448 DOI: 10.1017/s0022215123000932] [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: 11/06/2022] [Revised: 04/08/2023] [Accepted: 04/24/2023] [Indexed: 05/23/2023]
Abstract
OBJECTIVE To compare supraglottoplasty versus non-surgical treatment in children with laryngomalacia and mild, moderate and severe obstructive sleep apnoea. METHODS Patients were classified based on their obstructive apnoea hypopnoea index on initial polysomnogram, which was compared to their post-treatment polysomnogram. RESULTS Eighteen patients underwent supraglottoplasty, and 12 patients had non-surgical treatment. The average obstructive apnoea hypopnoea index after supraglottoplasty fell by 12.68 events per hour (p = 0.0039) in the supraglottoplasty group and 3.3 events per hour (p = 0.3) in the non-surgical treatment group. Comparison of the change in obstructive apnoea hypopnoea index in the surgical versus non-surgical groups did not meet statistical significance (p = 0.09). CONCLUSION All patients with laryngomalacia and obstructive sleep apnoea had a statistically significant improvement in obstructive apnoea hypopnoea index after supraglottoplasty irrespective of obstructive sleep apnoea severity, whereas patients who received non-surgical treatment had more variable and unpredictable results. Direct comparison of the change between the two groups did not find supraglottoplasty to be superior to non-surgical treatment. Larger prospective studies are recommended.
Collapse
Affiliation(s)
- Nicolas J Casellas
- Department of Otolaryngology, University of Rochester Medical Center, Rochester, NY, USA
| | - Shalini Shah
- University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
| | - Saiganesh Ravikumar
- University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
| | - Nathan D Vandjelovic
- Department of Otolaryngology, University of Rochester Medical Center, Rochester, NY, USA
| | - John Faria
- Department of Otolaryngology, University of Rochester Medical Center, Rochester, NY, USA
| | - Paul D Allen
- Department of Otolaryngology, University of Rochester Medical Center, Rochester, NY, USA
| | - Margo K McKenna Benoit
- Department of Otolaryngology, University of Rochester Medical Center, Rochester, NY, USA
| |
Collapse
|
3
|
Mills JF, Monaghan NP, Nguyen SA, Nguyen CL, Clemmens CS, Carroll WW, Pecha PP, White DR. Characteristics and outcomes of interventions for pediatric laryngomalacia: A systematic review with meta-analysis. Int J Pediatr Otorhinolaryngol 2024; 178:111896. [PMID: 38364547 DOI: 10.1016/j.ijporl.2024.111896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Revised: 02/07/2024] [Accepted: 02/11/2024] [Indexed: 02/18/2024]
Abstract
OBJECTIVES To analyze characteristics of children treated for laryngomalacia to determine predictive factors and provide an updated meta-analysis on outcomes. METHODS A systematic review was conducted according to PRISMA guidelines from inception to May 2, 2023, using CINAHL, PubMed, and Scopus databases. Study screening, data extraction, quality rating, and risk of bias assessment were performed by 2 independent reviewers. Data were meta-analyzed using fixed-/random-effects model to derive continuous measures (mean), proportions (%), and mean difference (Δ) with 95% confidence interval (CI). RESULTS 100 articles were identified with information on outcomes of pediatric patients with laryngomalacia (N = 18,317). The mean age was 10.6 months (range: 0 to 252, 95%CI: 9.6 to 11.6, p = 0.00) with a 1.4:1 male to female ratio. Many patients presented with stridor (87.9%, 95% CI: 69.8 to 98.4), and the most common comorbidity at time of diagnosis was gastroesophageal reflux disease (48.8%, 95%CI: 40.9 to 56.8). Based on the patient population included in our analysis, 86.1% received supraglottoplasty (95% CI: 78.7 to 92.1). A total of 73.6% (95% CI: 65.5 to 81.0) had reported complete resolution of symptoms. For patients with a concurrent diagnosis of sleep disordered breathing receiving supraglottoplasty, the apnea-hypopnea index improved with a mean difference of -10.0 (95%CI: 15.6 to -4.5) events per hour post-treatment. CONCLUSIONS Laryngomalacia continues to be a common problem in the pediatric population. Supraglottoplasty remains an effective treatment option leading to symptomatic improvement in many cases. For those with concurrent sleep disordered breathing, supraglottoplasty lowers the apnea-hypopnea index.
Collapse
Affiliation(s)
- John F Mills
- Department of Otolaryngology - Head and Neck Surgery, Medical University of South Carolina, 135 Rutledge Avenue, Charleston, SC, 29425, USA; Albany Medical College, 47 New Scotland Avenue, Albany, NY, 12208, USA
| | - Neil P Monaghan
- Department of Otolaryngology - Head and Neck Surgery, Medical University of South Carolina, 135 Rutledge Avenue, Charleston, SC, 29425, USA
| | - Shaun A Nguyen
- Department of Otolaryngology - Head and Neck Surgery, Medical University of South Carolina, 135 Rutledge Avenue, Charleston, SC, 29425, USA.
| | | | - Clarice S Clemmens
- Department of Otolaryngology - Head and Neck Surgery, Medical University of South Carolina, 135 Rutledge Avenue, Charleston, SC, 29425, USA
| | - William W Carroll
- Department of Otolaryngology - Head and Neck Surgery, Medical University of South Carolina, 135 Rutledge Avenue, Charleston, SC, 29425, USA
| | - Phayvanh P Pecha
- Department of Otolaryngology - Head and Neck Surgery, Medical University of South Carolina, 135 Rutledge Avenue, Charleston, SC, 29425, USA
| | - David R White
- Department of Otolaryngology - Head and Neck Surgery, Medical University of South Carolina, 135 Rutledge Avenue, Charleston, SC, 29425, USA
| |
Collapse
|
4
|
Díaz-García C, Valverde-Molina J, Martínez-Gimeno A, Antón-Pacheco Sánchez JL. Quality of life in children with diseases causing central airway obstruction: Reliability and validity of the TAPQOL questionnaire. Pediatr Pulmonol 2023; 58:279-287. [PMID: 36207999 DOI: 10.1002/ppul.26198] [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: 03/23/2022] [Revised: 08/09/2022] [Accepted: 09/01/2022] [Indexed: 01/11/2023]
Abstract
INTRODUCTION The aim of this study was to analyse the psychometric performance (reliability and validity) of the TAPQOL questionnaire in measuring the global quality of life in children with central airway obstruction (CAO), which encompasses pathologies with a low prevalence that have a common anatomical or functional affectation. METHOD The study population consisted of 109 patients with CAO attended in a national reference airway unitafter signing informed consent. The TAPQOL questionnaire was used to measure the global quality of life and its psychometric characteristics were analysed. The reliability was determined using Cronbach's α statistic and the validity was determined by means of a principal component analysis. RESULTS The mean age was 4.8 years and there was no predominant sex. The most frequent diagnosis was laryngomalacia (24.5%), followed bysubglotticstenosis (20.2%). The lowest score in the TAPQOL questionnaire was obtained for the scales of anxiety (66.2 ± 23.7), respiratory (67.9 ± 29.6), and conduct 68.2 ± 21.4). The Cronbach's α was above 0.7 in the majority of the scales and the validity study by principal component analysis with a total variance of 76.7% fits the original 12-component model. CONCLUSIONS TAPQOL is a valid tool to measure the health-related quality of life in patients with CAO. Measuring it in these patients indicates which fields are most affected, highlighting therapeutic needs that have not been resolved but which can be approached in normal clinical practice.
Collapse
Affiliation(s)
- Carolina Díaz-García
- Paediatric Pulmonology and Allergy Unit, Santa Lucia General University Hospital, Calle Loma Atlas, Cartagena, Murcia, Spain
| | - José Valverde-Molina
- Paediatrics Department, Santa Lucia General University Hospital, Cartagena, Murcia, Spain
| | | | - Juan L Antón-Pacheco Sánchez
- Paediatric Surgery Division & Paediatric Airway Unit, Hospital Universitario 12 de Octubre, Universidad Complutense, Madrid, Spain
| |
Collapse
|
5
|
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: 2] [Impact Index Per Article: 1.0] [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.
Collapse
|
6
|
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.
Collapse
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
| |
Collapse
|
7
|
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.
Collapse
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
| |
Collapse
|
8
|
Sivarajah S, Isaac A, Anderson S, Mehta D, Hong P, Alrajhi Y, El-Hakim H. Validity of laryngomalacia classification systems: A multi-institutional agreement study. Clin Otolaryngol 2020; 45:471-476. [PMID: 32198979 DOI: 10.1111/coa.13530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Revised: 02/18/2020] [Accepted: 03/08/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To determine the agreement of paediatric otolaryngologists on classifying laryngomalacia (LM). DESIGN Intra- and interobserver agreement study of two classification systems. SETTING Three tertiary referral paediatric centres. PARTICIPANTS Three paediatric otolaryngologists, who were blinded to any clinical details, interpreted the videos of children diagnosed with LM using the Holinger and Olney classifications independently. They rated the videos twice with a washout period of at least 2 weeks. THE MAIN OUTCOME MEASURES Inter- and intra-observer agreement measured by overall Fleiss kappa and unweighted Cohen's kappa coefficients. The secondary outcome measures were inter- and intra-observer agreement on the individual anatomical subunits of the supraglottis affected by LM, characterised by the subcategories of the classifications. RESULTS Video records of infants and children <18 years who had an endoscopic diagnosis of LM from 2012 to 2017 were retrospectively chosen for inclusion (n = 73). The overall Fleiss kappa coefficient was 0.25 (95% CI 0.18-0.32) amongst the raters using the Holinger classification and 0.31 (95% CI 0.21-0.42) for the Olney classification. Intra-observer agreement using the Holinger classification was 0.30 (95% CI 0.18-0.42), 0.62 (95% CI 0.23-0.85) and 0.84 (95% CI 0.75-0.94], whilst the Olney classification yielded values of 0.41 (95% CI 0.26-0.56), 0.51 (95% CI 0.29-0.63) and 0.63 (95% CI 0.48-0.78). CONCLUSIONS The agreement on types of LM between expert observers is modest using the Holinger and Olney classifications. This has significant implications for accurately diagnosing LM and exposes potential obstacles against credible pooling of data and extrapolation of information.
Collapse
Affiliation(s)
- Shanmugappiriya Sivarajah
- Division of Otolaryngology Head & Neck Surgery, Division of Pediatric Surgery, Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
| | - Andre Isaac
- Division of Otolaryngology Head & Neck Surgery, Division of Pediatric Surgery, Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
| | - Shelaina Anderson
- Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Deepak Mehta
- Bobby R. Alford Department of Otolaryngology Head and Neck Surgery, Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA
| | - Paul Hong
- Pediatric Otolaryngology, Division of Otolaryngology-Head & Neck Surgery, Department of Surgery, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Yaser Alrajhi
- Division of Otolaryngology Head & Neck Surgery, Division of Pediatric Surgery, Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
| | - Hamdy El-Hakim
- Division of Otolaryngology Head & Neck Surgery, Division of Pediatric Surgery, Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
| |
Collapse
|
9
|
Abstract
Congenital or acquired disorders of the pediatric airway can affect the upper, lower, or entire airway. There are fundamental differences between the anatomy and physiology of the neonate, pediatric, and adult airways. Infants are not merely small adults in this respect and size, surface area, proportion, resistance, and compliance vary greatly between the age groups. A clear understanding of these significant differences and how they affect patients dependent on age is key to appropriate management.
Collapse
Affiliation(s)
- Shyan Vijayasekaran
- Faculty of Medicine and health sciences, University of Western Australia, Perth, WA, Australia.,Department of Otolaryngology Head and Neck Surgery, Perth Children's hospital, Nedlands, WA, Australia
| |
Collapse
|