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Mills JF, Monaghan NP, Nguyen SA, O'Rourke AK, Halstead LA, Meyer TA. Adult Laryngomalacia: A Scoping Review. Otolaryngol Head Neck Surg 2024; 170:1020-1031. [PMID: 38219735 DOI: 10.1002/ohn.639] [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: 07/15/2023] [Revised: 12/14/2023] [Accepted: 12/17/2023] [Indexed: 01/16/2024]
Abstract
OBJECTIVE This review sought to determine the characteristics of adults diagnosed with new onset laryngomalacia including airway symptoms, laryngoscopic findings, treatments, and outcomes. Moreover, we wanted to highlight suspected limitations in the literature. DATA SOURCES Studies were identified through CINAHL, Cochrane Review, PubMed, and Scopus published between 1966 and 2023. REVIEW METHODS The search was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analysis Extension for Scoping Reviews checklist by 2 independent investigators. A meta-analysis of proportions and continuous measures was conducted. RESULTS Of the 1121 abstracts identified, 33 articles pertaining to laryngomalacia in the adult population were included. The most common presenting symptoms were stridor at rest (78.3%, 65.1-88.3) and dyspnea with exertion (83.8%, 64.8-96.3). The most suspected etiology was exercise-induced (86.0%, 69.4-95.5), and the most common description of laryngomalacia on visualization was collapse of supraglottic structures during exercise (93.3%, 79.0-99.1). Nonsurgical options were attempted in 87.0% (54.0-99.1), which included oral appliances, respiratory retraining, breathing techniques, and working with a speech pathologist. Surgical options were ultimately performed in 84.2% (75.0-91.0). Complete resolution of symptoms following therapy was seen in 61.9% (48.0-74.6). CONCLUSION Adult onset laryngomalacia is difficult to characterize. It typically presents in patients during exercise, with neurological injury, or idiopathically. Surgical management can lead to improvement or complete resolution of symptoms. The need for a universal nomenclature is highlighted in this review, as it is inconsistently classified.
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Affiliation(s)
- John F Mills
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
- Department of Otolaryngology-Head and Neck Surgery, Albany Medical College, Albany, New York, USA
| | - Neil P Monaghan
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Shaun A Nguyen
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Ashli K O'Rourke
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Lucinda A Halstead
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Ted A Meyer
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
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Ferri GM, Prakash Y, Levi JR, Tracy LF. Differential diagnosis and management of adult-onset laryngomalacia. Am J Otolaryngol 2020; 41:102469. [PMID: 32278471 DOI: 10.1016/j.amjoto.2020.102469] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Accepted: 03/29/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVE Adult-onset laryngomalacia is a rare clinical entity that has been infrequently reported. This study aims to evaluate the clinical presentation, diagnosis, and management of adult-onset laryngomalacia through literature review and report of a case. METHODS PubMed and Google Scholar databases were queried for articles published from 1960 to 2019 including only patients aged 18 years and older. Included keywords were: 'laryngomalacia', 'adult laryngomalacia', 'acquired laryngomalacia', 'idiopathic laryngomalacia', 'laryngeal obstruction', 'floppy epiglottis', 'floppy epiglottis', and 'epiglottis prolapse'. Data extracted from literature included clinical presentation, diagnostic workup, surgical management, and follow-up care. SOURCES PubMed and Google Scholar. RESULTS A total of 21 articles reported 41 cases of adult-onset laryngomalacia. Within these cases, 5 etiologies were identified: neurologic (n = 14), exercise-induced (n = 9), post-operative (n = 7), idiopathic (n = 7), and age-related (n = 4) laryngomalacia. Anterior prolapse of arytenoids and aryepiglottic folds was the most common laryngoscopic finding (n = 21), followed by posterior epiglottic prolapse (n = 20). Management included supraglottoplasty (n = 14), epiglottidectomy (n = 8) or epiglottopexy (n = 2). Neurologic etiology required tracheotomy more often than the other etiologies (n = 5, 36% vs. 15%). Three patients were managed expectantly without surgical intervention and reported symptom resolution. CONCLUSION Adult laryngomalacia is a rare diagnosis comprising a spectrum of disease. This diagnosis may be overlooked, but association with neurologic injury or trauma should encourage consideration. In comparison to pediatric laryngomalacia, patients often require surgical intervention. Surgical decision is based on the direction of supraglottic collapse, where supraglottoplasty and partial epiglottidectomy are effective interventions. LEVEL OF EVIDENCE N/A.
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Del Do M, Song SA, Nesbitt NB, Spaw MC, Chang ET, Liming BJ, Cable BB, Camacho M. Supraglottoplasty surgery types 1-3: A practical classification system for laryngomalacia surgery. Int J Pediatr Otorhinolaryngol 2018; 111:69-74. [PMID: 29958617 DOI: 10.1016/j.ijporl.2018.05.022] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Revised: 05/17/2018] [Accepted: 05/17/2018] [Indexed: 10/16/2022]
Abstract
OBJECTIVE The objective of this study is to review the published literature on supraglottoplasty techniques for correcting laryngomalacia, and to subsequently provide a standardized classification system. METHODS Three authors independently and systematically searched Pubmed/MEDLINE and six additional databases for all studies that included descriptions of supraglottoplasty techniques for correcting laryngomalacia. Sub-sites operated on and specific technique descriptions were reviewed, cataloged and subsequently categorized. This data was then used to develop a new classification system. RESULTS 231 articles were identified, downloaded and reviewed in full text. 53 articles with 1669 patients from the included articles described in detail the supraglottoplasty procedure. 84 articles with 5731 patients had to be excluded secondary to not providing detail about the supraglottoplasty procedure. The resultant data identifies the need for a more standardized reporting of the supraglottoplasty procedure in order to more accurately evaluate technique specific outcomes. Currently 77% of the patients in the literature cannot be assessed for outcomes as they did not describe the details for the procedures. Eight variations of supraglottoplasty and four variations of epiglottis surgery were described. Based on the literature, we consolidated the surgery into the following types: Type 1: Debulking of arytenoids, Type 2: Division of aryepiglottic folds, Type 3: Epiglottis surgery. CONCLUSION This descriptive review identified 53 articles with 1669 patients from the included articles detailing multiple variations of supraglottoplasty techniques. The new classification supplements a previously established system describing laryngomalacia, and simplifies the supraglottoplasty into three descriptive and logical types of categories. Our classification system would give surgeons a universal language to describe the supraglottoplasty performed, which could improve reporting of techniques, and facilitate future communication and research.
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Affiliation(s)
- Michael Del Do
- Otolaryngology-Head and Neck Surgery, 1 Jarrett White Road, Tripler Army Medical Center, HI, 96859, USA.
| | - Sungjin A Song
- Otolaryngology-Head and Neck Surgery, 1 Jarrett White Road, Tripler Army Medical Center, HI, 96859, USA
| | - Nicholas B Nesbitt
- School of Medicine, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Rd, Bethesda, MD, 20814, USA
| | - Mark C Spaw
- Otolaryngology-Head and Neck Surgery, 1 Jarrett White Road, Tripler Army Medical Center, HI, 96859, USA
| | - Edward T Chang
- Otolaryngology-Head and Neck Surgery, 1 Jarrett White Road, Tripler Army Medical Center, HI, 96859, USA
| | - Bryan J Liming
- Otolaryngology-Head and Neck Surgery, Division of Pediatric Otolaryngology, 1 Jarrett White Road, Tripler Army Medical Center, HI, 96859, USA.
| | - Benjamin B Cable
- Otolaryngology-Head and Neck Surgery, Division of Pediatric Otolaryngology, 1 Jarrett White Road, Tripler Army Medical Center, HI, 96859, USA
| | - Macario Camacho
- Otolaryngology-Head and Neck Surgery, Division of Sleep Surgery and Medicine, 1 Jarrett White Road, Tripler Army Medical Center, HI, 96859, USA.
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Takeshita J, Nishiyama K, Fujii M, Tanaka H, Beppu S, Sasahashi N, Shime N. Repetitive postoperative extubation failure and cardiac arrest due to laryngomalacia after general anesthesia in an elderly patient: a case report. J Anesth 2017; 31:779-781. [PMID: 28508288 DOI: 10.1007/s00540-017-2373-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Accepted: 05/01/2017] [Indexed: 11/29/2022]
Abstract
The authors report a case involving an elderly patient who experienced repetitive perioperative cardiac arrest caused by laryngomalacia. The patient underwent surgery under general anesthesia; however, 2 h after initial extubation, he experienced cardiopulmonary arrest. Return of spontaneous circulation was achieved by immediate resuscitation. Four hours later, a second extubation was performed without any neurological complications. However, 2 h later, he experienced cardiopulmonary arrest again. Immediately after the third extubation, 12 h after the second cardiopulmonary arrest, fiberoptic laryngoscopy revealed laryngomalacia. His respiratory condition stabilized after emergent tracheostomy. Laryngomalacia should be considered even in adult cases when signs of upper airway obstruction manifest after extubation.
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Affiliation(s)
- Jun Takeshita
- Department of Emergency and Critical Care Medicine, National Hospital Organization, Kyoto Medical Center, 1-1 Fukakusa, Mukaihata-cho, Fushimi-ku, Kyoto, 612-8555, Japan.
| | - Kei Nishiyama
- Department of Emergency and Critical Care Medicine, National Hospital Organization, Kyoto Medical Center, 1-1 Fukakusa, Mukaihata-cho, Fushimi-ku, Kyoto, 612-8555, Japan
| | - Masashi Fujii
- Department of Anesthesiology, Nagahama Red Cross Hospital, Shiga, Japan
| | - Hiroyuki Tanaka
- Department of Emergency and Critical Care Medicine, National Hospital Organization, Kyoto Medical Center, 1-1 Fukakusa, Mukaihata-cho, Fushimi-ku, Kyoto, 612-8555, Japan
| | - Satoru Beppu
- Department of Emergency and Critical Care Medicine, National Hospital Organization, Kyoto Medical Center, 1-1 Fukakusa, Mukaihata-cho, Fushimi-ku, Kyoto, 612-8555, Japan
| | - Nozomu Sasahashi
- Department of Emergency and Critical Care Medicine, National Hospital Organization, Kyoto Medical Center, 1-1 Fukakusa, Mukaihata-cho, Fushimi-ku, Kyoto, 612-8555, Japan
| | - Nobuaki Shime
- Department of Emergency and Critical Care Medicine, Institute of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
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Camacho M, Dunn B, Torre C, Sasaki J, Gonzales R, Liu SYC, Chan DK, Certal V, Cable BB. Supraglottoplasty for laryngomalacia with obstructive sleep apnea: A systematic review and meta-analysis. Laryngoscope 2015; 126:1246-55. [PMID: 26691675 DOI: 10.1002/lary.25827] [Citation(s) in RCA: 57] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/16/2015] [Indexed: 11/09/2022]
Abstract
OBJECTIVES/HYPOTHESIS To determine if apnea-hypopnea index (AHI) and lowest oxygen saturation (LSAT) improve following isolated supraglottoplasty for laryngomalacia with obstructive sleep apnea (OSA) in children. STUDY DESIGN Systematic review and meta-analysis. METHODS Nine databases, including PubMed/MEDLINE, were searched through September 30, 2015. RESULTS A total of 517 studies were screened; 57 were reviewed; and 13 met criteria. One hundred thirty-eight patients were included (age range: 1 month-12.6 years). Sixty-four patients had sleep exclusive laryngomalacia, and in these patients: 1) AHI decreased from a mean (M) ± standard deviation (SD) of 14.0 ± 16.5 (95% confidence interval [CI] 10.0, 18.0) to 3.3 ± 4.0 (95% CI 2.4, 4.4) events/hour (relative reduction: 76.4% [95% CI 53.6, 106.4]); 2) LSAT improved from a M ± SD of 84.8 ± 8.4% (95% CI 82.8, 86.8) to 87.6 ± 4.4% (95% CI 86.6, 88.8); 3) standardized mean differences (SMD) demonstrated a small effect for LSAT and a large effect for AHI; and 4) cure (AHI < 1 event/hour) was 10.5% (19 patients with individual data). Seventy-four patients had congenital laryngomalacia, and in these patients: 1) AHI decreased from a M ± SD of 20.4 ± 23.9 (95% CI 12.8, 28.0) to 4.0 ± 4.5 (95% CI 2.6, 5.4) events/hour (relative reduction: 80.4% [95% CI 46.6, 107.4]); 2) LSAT improved from a M ± SD of 74.5 ± 11.9% (95% CI 70.9, 78.1) to 88.4 ± 6.6% (95% CI 86.4, 90.4); 3) SMD demonstrated a large effect for both AHI and LSAT; and 4) cure was 26.5% (38 patients with individual data). CONCLUSION Supraglottoplasty has improved AHI and LSAT in children with OSA and either sleep exclusive laryngomalacia or congenital laryngomalacia; however, the majority of them are not cured. Laryngoscope, 126:1246-1255, 2016.
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Affiliation(s)
- Macario Camacho
- Otolaryngology-Head and Neck Surgery, Division of Sleep Surgery and Medicine, Tripler Army Medical Center, Honolulu, Hawaii.,Department of Psychiatry and Behavioral Sciences, Sleep Medicine Division, Stanford Hospital and Clinics, Stanford Hospital and Clinics, Stanford, California, U.S.A
| | - Brandyn Dunn
- John A. Burns School of Medicine, University of Hawaii, Honolulu, Hawaii
| | - Carlos Torre
- Department of Otolaryngology-Head and Neck Surgery, Division of Sleep Surgery, Stanford Hospital and Clinics, Stanford, California, U.S.A
| | - Jodie Sasaki
- John A. Burns School of Medicine, University of Hawaii, Honolulu, Hawaii
| | - Raymond Gonzales
- Department of Otorhinolaryngology/Sleep Medicine Centre-Hospital CUF, University of Porto, Porto, Portugal
| | - Stanley Yung-Chuan Liu
- Department of Otolaryngology-Head and Neck Surgery, Division of Pediatric Otolaryngology, University of California San Francisco, San Francisco, California, U.S.A
| | - Dylan K Chan
- School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland, U.S.A
| | - Victor Certal
- CINTESIS-Centre for Research in Health Technologies and Information Systems, University of Porto, Porto, Portugal
| | - Benjamin B Cable
- Otolaryngology-Head and Neck Surgery, Division of Sleep Surgery and Medicine, Tripler Army Medical Center, Honolulu, Hawaii
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Gazzaz MJ, El-Hakim H. A case of acquired laryngomalacia in an infant, with endoscopy before and after establishing the diagnosis for the first time. BMJ Case Rep 2015; 2015:bcr-2015-213264. [PMID: 26628452 DOI: 10.1136/bcr-2015-213264] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A 12-week-old infant girl born at 27 weeks gestation, with multiple comorbidities, was referred to the paediatric otolaryngology team due to stridor and feeding difficulties. Initial airway endoscopy was performed, showing no abnormal findings. The infant underwent frequent hospitalisations for recurrent cyanotic spells. Despite initial laryngoscopy and bronchoscopy not showing abnormalities, a repeat endoscopy demonstrated laryngomalacia, significant enough to require a supraglottoplasty. This is the first report to confirm, with video evidence, that some cases of laryngomalacia are acquired rather than congenital, even in infancy.
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Affiliation(s)
- Malak Jamal Gazzaz
- Department of Otolaryngology-Head and Neck Surgery, University of Alberta, Edmonton, Alberta, Canada
| | - Hamdy El-Hakim
- Department of Pediatric Otolaryngology, University of Alberta, Edmonton, Alberta, Canada
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Hey SY, Oozeer NB, Robertson S, MacKenzie K. Adult-onset laryngomalacia: case reports and review of management. Eur Arch Otorhinolaryngol 2014; 271:3127-32. [DOI: 10.1007/s00405-014-2945-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2013] [Accepted: 02/07/2014] [Indexed: 11/24/2022]
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