Current Otorhinolaryngology Reports

, Volume 6, Issue 1, pp 107–114 | Cite as

Pediatric Swallowing Function in the Presence of Laryngeal Cleft and Laryngomalacia: a Review of the Literature

  • Margaret Cafferkey
  • Bridget M. Harrington
Pediatric Otolaryngology (K Rosbe, Section Editor)
Part of the following topical collections:
  1. Topical Collection on Pediatric Otolaryngology


Purpose of Review

The etiologies of pediatric dysphagia are complex and varied, and the impact of medical and surgical interventions for laryngeal anomalies on pediatric swallow function is still being defined. We aim to review recent literature on evaluation and management of pediatric dysphagia for children with laryngomalacia (LM) and laryngeal cleft (LC).


A review of the literature over the last 5 years was completed using search engines PubMed and Google Scholar. Specific journals reviewed include “The International Journal of Pediatric Otorhinolaryngology,” “Dysphagia,” “JAMA Otolaryngology Head and Neck Surgery,” and “The Laryngoscope.” Articles were identified which discuss management of laryngomalacia and laryngeal cleft and the impact on pediatric dysphagia.


Management of pediatric dysphagia for patients diagnosed with LM and LC requires multiple considerations including timing of interventions, presence of comorbidities, and coordinated care with multidisciplinary teams. Evaluation of swallow function with the appropriate test at the right time interval is critical for improved patient outcomes and patient safety. Trends toward use of evidence-based clinical pathways are encouraged and supported by recent literature.


Pediatric dysphagia Laryngeal cleft Laryngomalacia Aspiration 



The authors appreciate the assistance provided by Kristina W. Rosbe, MD, FAAP, FACS; Sarah Schneider, MS CCC-SLP; and Angela Haas, MA CCC-SLP, in formatting and editing this paper. The authors would also like to acknowledge, research assistant, Madeline Helmig, BS for her assistance in initial research compilation.

Compliance with Ethical Standards

Conflict of Interest

The authors declare that they have no conflict of interest.

Human and Animal Rights

This article does not contain any studies with human or animal subjects performed by any of the authors.


Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. 1.
    Lefton-Greif M, Arvedson J. Pediatric feeding/swallowing: yesterday, today, and tomorrow. Semin Speech. 2016; 37(04): 298-309.Google Scholar
  2. 2.
    Bhattacharyya N. The prevalence of pediatric voice and swallowing problems in the United States. Laryngoscope. 2015;125(3):746–50. Scholar
  3. 3.
    Durvasula VSPB, O’Neill AC, Richter GT. Oropharyngeal dysphagia in children: mechanism, source, and management. Otolaryngol Clin N Am. 2014;47(5):691–720. Scholar
  4. 4.
    Arvedson J, Lefton-Greif M. Instrumental assessment of pediatric dysphagia. Semin Speech. 2017; 38(02): 135-146.Google Scholar
  5. 5.
    Miller CK. Aspiration and swallowing dysfunction in pediatric patients. Infant Child Adolesc Nutr. 2011;3(6):336–43. Scholar
  6. 6.
    Langmore SE, Schatz K, Olson N. Endoscopic and videofluoroscopic evaluations of swallowing and aspiration. Ann Otol Rhinol. 1991;100(8):678–81. Scholar
  7. 7.
    •• Simons JP, Greenberg LL, Mehta DK, Fabio A, Maguire RC, Mandell DL. Laryngomalacia and swallowing function in children. Laryngoscope. 2016;126(2):478–84. Scholar
  8. 8.
    • Chun RH, Wittkopf M, Sulman C, Arvedson J. Transient swallowing dysfunction in typically developing children following supraglottoplasty for laryngomalacia. Int J Pediatr Otorhinolaryngol. 2014;78(11):1883–5. Scholar
  9. 9.
    Thompson DM. Laryngomalacia: factors that influence disease severity and outcomes of management. Curr Opin Otolaryngol Head Neck Surg. 2010;18(6):564–70. Scholar
  10. 10.
    Parkes WJ, Propst EJ. Advances in the diagnosis, management, and treatment of neonates with laryngeal disorders. Semin Fetal Neonatal Med. 2016;21(4):270–6. Scholar
  11. 11.
    Isaac A, Zhang H, Soon SR, Campbell S, El-Hakim H. A systematic review of the evidence on spontaneous resolution of laryngomalacia and its symptoms. Int J Pediatr Otorhinolaryngol. 2016;83:78–83. Scholar
  12. 12.
    Thorne MC, Garetz SL. Laryngomalacia: review and summary of current clinical practice in 2015. Paediatr Respir Rev. 2016;17:3–8. Scholar
  13. 13.
    Chen JL, Messner AH, Chang KW. Familial laryngomalacia in two siblings with syndromic features. Int J Pediatr Otorhinolaryngol. 2006;70(9):1651–5. Scholar
  14. 14.
    Bedwell J, Zalzal G. Laryngomalacia. Semin Pediatr Surg. 2016;25(3):119–22. Scholar
  15. 15.
    • Ojha S, Ashland JE, Hersh C, Ramakrishna J, Maurer R, Hartnick CJ. Type 1 laryngeal cleft. JAMA Otolaryngol Neck Surg. 2014;140(1):34–40. Scholar
  16. 16.
    Leboulanger N, Garabédian E-N. Laryngo-tracheo-oesophageal clefts. Orphanet J Rare Dis. 2011;6(1):81. Scholar
  17. 17.
    •• Gasparin M, Schweiger C, Manica D, Maciel AC, Kuhl G, Levy DS, et al. Accuracy of clinical swallowing evaluation for diagnosis of dysphagia in children with laryngomalacia or glossoptosis. Pediatr Pulmonol. 2017;52(1):41–7. Scholar
  18. 18.
    • Thottam PJ, Simons JP, Choi S, Maguire R, Mehta DK. Clinical relevance of quality of life in laryngomalacia. Laryngoscope. 2016;126(5):1232–5. Scholar
  19. 19.
    •• Faria J, Behar P. Medical and surgical Management of Congenital Laryngomalacia: a case-control study. Otolaryngol Head Neck Surg. 2014;151(5):845–51. Scholar
  20. 20.
    Benjamin B, Inglis A. Minor congenital laryngeal clefts: diagnosis and classification. Ann Otol Rhinol Laryngol. 1989;98(6):417–20. Scholar
  21. 21.
    Roth B, Rose KG, Benz-Bohm G, Günther H. Laryngo-tracheo-oesophageal cleft—clinical features, diagnosis and therapy. Eur J Pediatr. 1983;140(1):41–6. Scholar
  22. 22.
    Parsons DS, Stivers FE, Giovanetto DR, Phillips SE. Type I posterior laryngeal clefts. Laryngoscope. 1998;108(3):403–10. Scholar
  23. 23.
    • Walker RD, Irace AL, Kenna MA, Urion DK, Rahbar R. Neurologic evaluation in children with laryngeal cleft. JAMA Otolaryngol Neck Surg. 2017;2115:1–5.Google Scholar
  24. 24.
    Evans JNG. Management of the cleft larynx and tracheoesophageal clefts. Ann Otol Rhinol Laryngol. 1985;94(6):627–30. Scholar
  25. 25.
    Chien W, Ashland J, Haver K, Hardy SC, Curren P, Hartnick CJ. Type 1 laryngeal cleft: establishing a functional diagnostic and management algorithm. Int J Pediatr Otorhinolaryngol. 2006;70(12):2073–9. Scholar
  26. 26.
    •• Osborn AJ, De Alarcon A, Tabangin ME, Miller CK, Cotton RT, Rutter MJ. Swallowing function after laryngeal cleft repair: more than just fixing the cleft. Laryngoscope. 2014;124(8):1965–9. Scholar
  27. 27.
    Rosenbek J, Robbins J, Roecker E, Coyle J, Wood J. A penetration aspiration scale. Dysphagia. 1996;11:93–8.CrossRefPubMedGoogle Scholar
  28. 28.
    •• Strychowsky JE, Dodrill P, Moritz E, Perez J, Rahbar R. Swallowing dysfunction among patients with laryngeal cleft: more than just aspiration? Int J Pediatr Otorhinolaryngol. 2016;82:38–42.CrossRefPubMedGoogle Scholar
  29. 29.
    Crary MA, Carnaby Mann GD, Groher ME. Initial psychometric assessment of a functional oral intake scale for dysphagia in stroke patients. Arch Phys Med Rehabil. 2005;86(8):1516–20. Scholar
  30. 30.
    Hersh C, Wentland C, Sally S, de Stadler M, Hardy S, Fracchia MS, et al. Radiation exposure from videofluoroscopic swallow studies in children with a type 1 laryngeal cleft and pharyngeal dysphagia: a retrospective review. Int J Pediatr Otorhinolaryngol. 2016;89:92–6. Scholar
  31. 31.
    Wentland C, Hersh C, Sally S, Fracchia MS, Hardy S, Liu B, et al. Modified best-practice algorithm to reduce the number of postoperative videofluoroscopic swallow studies in patients with type 1 laryngeal cleft repair. JAMA Otolaryngol Neck Surg. 2016;142(9):851–6. Scholar
  32. 32.
    Chiang T, McConnell B, Ruiz AG, DeBoer EM, Prager JD. Surgical management of type I and II laryngeal cleft in the pediatric population. Int J Pediatr Otorhinolaryngol. 2014;78(12):2244–9. Scholar
  33. 33.
    Thottam PJ, Georg M, Chi D, Mehta DK. Outcomes and predictors of surgical management in type 1 laryngeal cleft swallowing dysfunction. Laryngoscope. 2016;126(12):2838–43. Scholar
  34. 34.
    McGee K. The role of a child life specialist in a pediatric radiology department. Pediatr Radiol. 2003;33(7):467–74. Scholar
  35. 35.
    Fracchia MS, Diercks G, Yamasaki A, Hersh C, Hardy S, Hartnick M, et al. Assessment of the feeding swallowing impact survey as a quality of life measure in children with laryngeal cleft before and after repair. Int J Pediatr Otorhinolaryngol. 2017;99:73–7.CrossRefPubMedGoogle Scholar
  36. 36.
    McSweeney ME, Kerr J, Amirault J, Mitchell PD, Larson K, Rosen R. Oral feeding reduces hospitalizations compared with gastrostomy feeding in infants and children who aspirate. J Pediatr. 2016;170:79–84. Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Speech Pathology in Department of Pediatric Otolaryngology, Head and Neck Surgery, Benioff Children’s Hospital, Voice and Swallowing CenterUniversity of California San FranciscoSan FranciscoUSA
  2. 2.Department of Audiology, Speech Pathology and Learning ServicesChildren’s Hospital ColoradoAuroraUSA

Personalised recommendations