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International Journal of Pediatric... Jul 2016To provide recommendations for the comprehensive management of young infants who present with signs or symptoms concerning for laryngomalacia. (Review)
Review
OBJECTIVE
To provide recommendations for the comprehensive management of young infants who present with signs or symptoms concerning for laryngomalacia.
METHODS
Expert opinion by the members of the International Pediatric Otolaryngology Group (IPOG).
RESULTS
Consensus recommendations include initial care and triage recommendations for health care providers who commonly evaluate young infants with noisy breathing. The consensus statement also provides comprehensive care recommendations for otolaryngologists who manage young infants with laryngomalacia including: evaluation and treatment considerations for commonly debated issues in laryngomalacia, initial work-up of infants presenting with inspiratory stridor, treatment recommendations based on disease severity, management of the infant with feeding difficulties, post-surgical treatment management recommendations, and suggestions for acid suppression therapy.
CONCLUSION
Laryngomalacia care consensus recommendations are aimed at improving patient-centered care in infants with laryngomalacia.
Topics: Algorithms; Consensus; Disease Management; Female; Humans; Infant; Infant, Newborn; Laryngomalacia; Male; Patient-Centered Care; Practice Guidelines as Topic; Respiratory Sounds; Triage
PubMed: 27107728
DOI: 10.1016/j.ijporl.2016.04.007 -
Pediatric Clinics of North America Aug 2013Laryngomalacia is the most common cause of stridor in infants. Stridor results from upper airway obstruction caused by collapse of supraglottic tissue into the airway.... (Review)
Review
Laryngomalacia is the most common cause of stridor in infants. Stridor results from upper airway obstruction caused by collapse of supraglottic tissue into the airway. Most cases of laryngomalacia are mild and self-resolve, but severe symptoms require investigation and intervention. There is a strong association with gastroesophageal reflux disease in patients with laryngomalacia, and thus medical treatment with antireflux medications may be indicated. Supraglottoplasty is the preferred surgical treatment of laryngomalacia, reserved only for severe cases. Proper identification of those patients who require medical and surgical intervention is key to providing treatment with successful outcomes.
Topics: Gastroesophageal Reflux; Humans; Infant; Infant, Newborn; Laryngomalacia; Laryngoscopy; Respiratory Sounds; Risk Factors; Severity of Illness Index
PubMed: 23905826
DOI: 10.1016/j.pcl.2013.04.013 -
Seminars in Pediatric Surgery Jun 2016Laryngomalacia is the most common cause of stridor in neonates. It typically presents with inspiratory stridor and is often associated with feeding problems. Severe... (Review)
Review
Laryngomalacia is the most common cause of stridor in neonates. It typically presents with inspiratory stridor and is often associated with feeding problems. Severe cases present with stridor, apnea, significant respiratory distress, and failure to thrive. Most patients are managed conservatively and can expect to see symptom resolution by 12-24 months of age. About 10% of patients require surgical treatment for their symptoms. Supraglottoplasty is the surgical technique of choice. Results of this surgery are excellent, and severe complications, such as supraglottic stenosis and aspiration, are uncommon. Supraglottoplasty is less effective in patients with significant comorbidities such as neurologic conditions and syndromes.
Topics: Epiglottis; Humans; Infant, Newborn; Laryngomalacia; Tracheostomy
PubMed: 27301595
DOI: 10.1053/j.sempedsurg.2016.02.004 -
NeoReviews Oct 2021Laryngomalacia is the most common cause of stridor in newborns. Affected patients may present with noisy breathing, a classic high-pitched inspiratory stridor that... (Review)
Review
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.
Topics: Epiglottis; Failure to Thrive; Humans; Infant; Infant, Newborn; Infant, Premature; Laryngomalacia; Respiratory Sounds
PubMed: 34599063
DOI: 10.1542/neo.22-10-e653 -
The Journal of Laryngology and Otology Nov 2017The advent of supraglottoplasty clearly has transformed the surgical management of severe laryngomalacia. The condition, however, generally runs a milder course, with... (Review)
Review
BACKGROUND
The advent of supraglottoplasty clearly has transformed the surgical management of severe laryngomalacia. The condition, however, generally runs a milder course, with spontaneous resolution the norm.
OBJECTIVES
To identify gaps in the knowledge and identify topics for future study.
METHOD
Systematic review of the literature.
RESULTS
The literature suggests that there is a range of abnormalities leading to the typical collapsing upper airway, and that neurological disease, other airway abnormalities, syndromes and gastroesophageal reflux all contribute to disease severity and influence outcomes. The procedures involved in supraglottoplasty are rarely specified, the indications for surgery are vaguely defined and the role of medical therapy is unclear.
CONCLUSION
Every review article or survey of opinion suggests that there is still a marked variation in individual practice and a lack of consensus.
Topics: Glottis; Humans; Laryngomalacia; Larynx; Treatment Outcome
PubMed: 29067893
DOI: 10.1017/S0022215117002092 -
Current Problems in Pediatric and... Apr 2018Airway malacia can occur in the larynx (larygomalacia), trachea (tracheomalacia), or bronchi (bronchomalacia). As a group these are the most common congenital... (Review)
Review
Airway malacia can occur in the larynx (larygomalacia), trachea (tracheomalacia), or bronchi (bronchomalacia). As a group these are the most common congenital abnormalities of the pediatric airway and are characterized by increased airway compliance, resulting in excessive dynamic collapse during the respiratory cycle. While a diagnosis can be suspected based on clinical history and physical examination, definitive evaluation is based of nasopharyngolaryngoscopy and/or bronchoscopy. Observation and conservative management are typically all that are required. However, surgical intervention can be necessary in the most severe cases, and can result in significant improvement in symptoms.
Topics: Bronchomalacia; Bronchoscopy; Conservative Treatment; Humans; Laryngomalacia; Pediatrics; Severity of Illness Index; Tracheomalacia; Watchful Waiting
PubMed: 29622320
DOI: 10.1016/j.cppeds.2018.03.002 -
European Annals of Otorhinolaryngology,... Feb 2013Laryngomalacia is the most common laryngeal disease of infancy. It is poorly tolerated in 10% of cases, requiring assessment and management, generally surgical. Surgery... (Review)
Review
Laryngomalacia is the most common laryngeal disease of infancy. It is poorly tolerated in 10% of cases, requiring assessment and management, generally surgical. Surgery often consists of supraglottoplasty, for which a large number of technical variants have been described. This surgery, performed in an appropriate setting, relieves the symptoms in the great majority of cases with low morbidity. However, few data are available concerning the objective results: preoperative and postoperative objective assessment of these infants is therefore necessary whenever possible. Noninvasive ventilation (NIV) may be indicated in some infants with comorbid conditions or failing to respond to surgical management.
Topics: Anesthesia, General; Diagnosis, Differential; Epiglottis; France; Humans; Infant; Infant, Newborn; Laryngomalacia; Laryngoscopy; Laser Therapy; Lasers, Gas; Microsurgery; Postoperative Care; Preoperative Care; Respiratory Sounds; Tracheotomy; Treatment Outcome
PubMed: 22835508
DOI: 10.1016/j.anorl.2012.04.003 -
Otolaryngology--head and Neck Surgery :... Apr 2024This review sought to determine the characteristics of adults diagnosed with new onset laryngomalacia including airway symptoms, laryngoscopic findings, treatments, and... (Meta-Analysis)
Meta-Analysis Review
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.
Topics: Adult; Humans; Laryngomalacia; Larynx; Laryngoscopy; Laryngoplasty; Dyspnea
PubMed: 38219735
DOI: 10.1002/ohn.639 -
Acta Oto-laryngologica Jan 2021Laryngomalacia is the commonest laryngeal anomaly and cause of stridor in children. Although most cases are self-limiting, failure to thrive, hypoxaemia or significant...
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.
Topics: Child, Preschool; Eosinophils; Female; Humans; Infant; Infant, Newborn; Laryngomalacia; Laryngoplasty; Larynx; Male; Retrospective Studies
PubMed: 33393421
DOI: 10.1080/00016489.2020.1821246