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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.
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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
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Salloum S, Mahsoun Y, Al-Khatib T, Marzouki H, Zawawi F. Supraglottoplasty in the management of laryngomalacia in children with down syndrome: A systematic review. Int J Pediatr Otorhinolaryngol 2021; 142:110630. [PMID: 33477012 DOI: 10.1016/j.ijporl.2021.110630] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 12/18/2020] [Accepted: 01/12/2021] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Children with Down syndrome (DS) who have Laryngomalacia represent a specific management challenge due to their inherent multiple levels of airway obstruction and hypotonia. Therefore, the purpose of this study is to determine the outcome of supraglottoplasty (SGP) in children with DS. DATA SOURCE A systematic review was performed following the PRISMA guideline. Data were collected from online medical databases- CINAHL, Cochrane Library, Google Scholar, Ovid MEDLINE, Ovid MEDLINE in process, PubMed, and Scopus. REVIEW METHODS all publications that address the outcome of supraglottoplasty in children who are less than 18 years old with Down syndrome prior to December 2018 were collected. The data were collected on different phases: Screening review using search words and controlled vocabularies during the period of November-December 2018, followed by a detailed review of screened articles based on inclusion and exclusion criteria, then a full review that included screening the references of selected articles. RESULTS Nine articles were included in the qualitative analysis. These articles included 231 subjects, out of which 32 children with DS met the inclusion criteria. Twenty patients (62.5%) were considered successfully treated and 12/32 failed including 1/32 (3.1%) mortality in the postoperative period. The duration of follow-up was 12-102 days. All of the patients whose treatment failed had significant comorbidities. CONCLUSION Although the success of SPG in children with DS is less than in otherwise healthy children, it remains an option especially in patients without comorbidities. Preoperative counseling of the families and thorough assessment are necessary to determine candidacy for SPG in children with DS.
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Affiliation(s)
- Sara Salloum
- Department of Otolaryngology, Head and Neck Surgery, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Yasmina Mahsoun
- Department of Otolaryngology, Head and Neck Surgery, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Talal Al-Khatib
- Department of Otolaryngology, Head and Neck Surgery, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - HaniZ Marzouki
- Department of Otolaryngology, Head and Neck Surgery, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Faisal Zawawi
- Department of Otolaryngology, Head and Neck Surgery, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia.
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Gan RWC, Moustafa A, Turner K, Knight L. Histopathology of laryngomalacia. Acta Otolaryngol 2021; 141:85-88. [PMID: 33393421 DOI: 10.1080/00016489.2020.1821246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Laryngomalacia is the commonest laryngeal anomaly and cause of stridor in children. Although most cases are self-limiting, failure to thrive, hypoxaemia or significant apnoeic episodes may warrant surgical intervention in the form of aryepiglottoplasty. Opinion is divided as to the pathophysiological mechanisms involved in the disease process. AIMS AND OBJECTIVES This study explores the aetiology of laryngomalacia by reviewing the histology of aryepiglottoplasty resection specimens. MATERIAL AND METHODS The histology reports of 61 aryepiglottoplasty specimens resected between 1 October 2014 and 31 October 2018 were reviewed. RESULTS Age of patients ranged from 3 weeks to 36 months. 36 patients were male and 25 female. 43 of 61 (70.5%) cases had inflammation, most of which were mild. 3 (4.9%) cases had histological specimens with detectable eosinophils. None of the specimens had signs of granulomatous change, ulceration or calcification. Cartilage was present in the resected specimen in 47 (77%) cases. Over half of these (59.6%) were immature cartilage. CONCLUSION AND SIGNIFICANCE The results suggest a mild concurrent laryngitis/supraglottitis in most cases. Eosinophilia is rare and does not support eosinophilic oesophageal reflux as part of the aetiology. The high proportion of immature cartilage in the specimens supports the theory of chondropathic aetiology.
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Affiliation(s)
| | - Ali Moustafa
- Ear, Nose and Throat Department, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Kerry Turner
- Cellular Pathology Department, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Lindsey Knight
- Ear, Nose and Throat Department, Leeds Teaching Hospitals NHS Trust, Leeds, UK
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Nagy P, Dudley S, Sheyn A. Supraglottoplasty in Neonates under One Month of Age. Ann Otol Rhinol Laryngol 2019; 129:494-497. [PMID: 31875410 DOI: 10.1177/0003489419896379] [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: 11/16/2022]
Abstract
OBJECTIVES Examine outcomes of patients 1 month of age or less who received supraglottoplasty. Demonstrate the feasibility and safety of supraglottoplasty in neonates <1 month of age. METHODS Charts were reviewed from 2015-2017. Patients with previously identified laryngomalacia requiring surgical intervention and age 1 month or less were identified. We collected data on age, gender, surgical technique, other airway lesions, time to extubation and discharge, and comorbidities. RESULTS Six patients met the inclusion criteria of which four were male and two were female. Average age at time of surgery was 19.5 days. All patients had diagnosis of laryngomalacia made on flexible or direct laryngoscopy with increased work of breathing, reports of cyanotic episodes, or oxygen desaturations. All had feeding difficulties, and three had signs and history consistent with gastroesophageal reflux. Two patients underwent supraglottoplasty by CO2 laser treatment alone, one patient received cold steel treatment alone, and the remaining three patients received cold steel with supplemental microdebrider treatment. Out of six patients, five were extubated within 5 days of their procedure. The average time to extubation was 1.8 days. The average time to discharge was 24.25 days following surgery. Two patients required revisions. CONCLUSIONS Supraglottoplasty in children younger than 1 month of age is rare. Despite the rare occurrence, it appears to be feasible early in life in treating laryngomalacia. Neonates with respiratory failure, apneas, and cyanosis, or difficulty feeding due to laryngomalacia should be evaluated and treated with supraglottoplasty.
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Affiliation(s)
- Peter Nagy
- Department of Otolaryngology, College of Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Samuel Dudley
- Department of Otolaryngology, College of Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Anthony Sheyn
- Department of Otolaryngology, College of Medicine, University of Tennessee Health Science Center, Memphis, TN, USA.,Department of Otolaryngology, St. Jude Children's Research Hospital, Memphis, TN, USA
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Avillion MP, Neighbors CLP, Biello A, Anderson LC, Liming BJ, Camacho M. Unilateral vs Bilateral Supraglottoplasty: A Meta-analysis of Rates of Return to Surgery and Supraglottic Stenosis. Otolaryngol Head Neck Surg 2019; 161:742-753. [PMID: 31184252 DOI: 10.1177/0194599819847644] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To perform a systematic review with meta-analysis of data to determine the rates of repeat surgery and supraglottic stenosis in unilateral versus bilateral supraglottoplasty for laryngomalacia. DATA SOURCES PubMed/Medline, Cochrane Central, Scopus, Google Scholar, Web of Science, and Embase. REVIEW METHODS Databases were searched through January 30, 2018. Studies with unilateral or bilateral supraglottoplasty techniques for laryngomalacia were included. The need for repeat (revision or completion) surgery and rates of supraglottic stenosis were primary outcomes. Data were substratified and a meta-analysis performed. RESULTS A total of 251 articles were reviewed, and 20 articles met inclusion criteria (1186 patients: 663 bilateral, 523 unilateral). Regarding the need to return to surgery, the rate of revision for bilateral surgery was 4.1%, compared to the revision and combined revision/completion rates for unilateral surgery which respectively were 1.1% (odds ratio [OR] 0.27; 95% CI 0.11-0.67; P = .002) and 18.0% (OR 5.16; 95% CI 3.31-8.06; P < .0001). The unilateral versus bilateral supraglottic stenosis rates were 0% versus 1.2% (P = .011). CONCLUSION Unilateral supraglottoplasty has a significantly higher rate of repeat surgery, mainly attributed to contralateral surgery, when compared with bilateral supraglottoplasty. There is a small but statistically significant risk of supraglottic stenosis in bilateral procedures. The benefit of a unilateral procedure should be weighed against the cost of subjecting patients to a 4-fold increased risk of repeat surgery.
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Affiliation(s)
- Michael P Avillion
- Otolaryngology-Head and Neck Surgery, Tripler Army Medical Center, Honolulu, Hawaii, USA
| | - Cindy Lee P Neighbors
- Otolaryngology-Head and Neck Surgery, Tripler Army Medical Center, Honolulu, Hawaii, USA
| | - Andrew Biello
- Otolaryngology-Head and Neck Surgery, Tripler Army Medical Center, Honolulu, Hawaii, USA
| | - Lauren C Anderson
- Natchitoches Regional Medical Center Ear, Nose and Throat, Natchitoches, Louisiana, USA
| | - Bryan J Liming
- Division of Pediatric Otolaryngology, Otolaryngology-Head and Neck Surgery, Tripler Army Medical Center, Honolulu, Hawaii, USA
| | - Macario Camacho
- Otolaryngology-Head and Neck Surgery, Division of Sleep Surgery and Medicine, Tripler Army Medical Center, Honolulu, Hawaii, USA
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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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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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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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