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Laryngomalacia

  • Bethany R. Powers
  • Bryn K. Olson-Greb
  • Jessica Van Beek-KingEmail author
Chapter

Abstract

Laryngomalacia is a congenital immaturity of the cartilages of the supraglottis that presents with high-pitched inspiratory stridor that worsens with crying, feeding, or lying supine. It is the most common cause of stridor in the newborn and usually presents around 2 weeks of age. However, it may also present anytime within the first 2–4 months of life (Bedwell and Zalzal, Semin Pediatr Surg 25(3):119–122, 2016; McSwiney et al. Arch Dis Child 52(3):215–218, 1977; Landry and Thompson, Int J Pediatr 2012:753526, 2012).

Laryngomalacia symptoms typically peak at age 6–8 months and resolve by age 12–24 months (Landry and Thompson, Int J Pediatr 2012:753526, 2012). About 10% of laryngomalacia cases will require surgical intervention for apnea or failure to thrive secondary to feeding intolerance or utilizing excessive calories for respiration.

Keywords

Laryngomalacia Gastroesophageal and laryngopharyngeal reflux Polysomnography and laryngomalacia Supraglottoplasty Secondary airway lesions in infants with laryngomalacia 

References

  1. 1.
    Bedwell J, Zalzal G. Laryngomalacia. Semin Pediatr Surg. 2016;25(3):119–22.  https://doi.org/10.1053/j.sempedsurg.2016.02.004. Epub 2016 Feb 18. Review. PubMed PMID: 27301595.CrossRefPubMedGoogle Scholar
  2. 2.
    McSwiney PF, Cavanagh NP, Languth P. Outcome in congenital stridor (laryngomalacia). Arch Dis Child. 1977;52(3):215–8. PubMed PMID: 849000; PubMed Central PMCID: PMC1546273.CrossRefGoogle Scholar
  3. 3.
    Landry AM, Thompson DM. Laryngomalacia: disease presentation, spectrum, and management. Int J Pediatr. 2012;2012:753526.  https://doi.org/10.1155/2012/753526. Epub 2012 Feb 27. PubMed PMID: 22518182; PubMed Central PMCID: PMC3299329.CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Kay DJ, Goldsmith AJ. Laryngomalacia: a classification system and surgical treatment strategy. Ear Nose Throat J. 2006;85(5):328–31, 336. PubMed PMID: 16771027.CrossRefGoogle Scholar
  5. 5.
    Olney DR, Greinwald JH Jr, Smith RJ, Bauman NM. Laryngomalacia and its treatment. Laryngoscope. 1999;109(11):1770–5. PubMed PMID: 10569405.CrossRefGoogle Scholar
  6. 6.
    Thompson DM. Laryngomalacia: factors that influence disease severity and outcomes of management. Curr Opin Otolaryngol Head Neck Surg. 2010;18(6):564–70.  https://doi.org/10.1097/MOO.0b013e3283405e48. Review. PubMed PMID: 20962644.CrossRefPubMedGoogle Scholar
  7. 7.
    Richter GT, Thompson DM. The surgical management of laryngomalacia. Otolaryngol Clin N Am. 2008;41(5):837–864, vii.  https://doi.org/10.1016/j.otc.2008.04.011. Review. PubMed PMID: 18775337.CrossRefGoogle Scholar
  8. 8.
    Giannoni C, Sulek M, Friedman EM, Duncan NO 3rd. Gastroesophageal reflux association with laryngomalacia: a prospective study. Int J Pediatr Otorhinolaryngol. 1998;43(1):11–20. PubMed PMID: 9596365.CrossRefGoogle Scholar
  9. 9.
    Sedaghat S, Fredes F, Tapia M. Supraglottoplasty for laryngomalacia: the experience from Concepcion, Chile. Int J Pediatr Otorhinolaryngol. 2017;103:113–6.  https://doi.org/10.1016/j.ijporl.2017.10.012. Epub 2017 Oct 7.CrossRefPubMedGoogle Scholar
  10. 10.
    Schroeder JW Jr, Bhandarkar ND, Holinger LD. Synchronous airway lesions and outcomes in infants with severe laryngomalacia requiring supraglottoplasty. Arch Otolaryngol Head Neck Surg. 2009;135(7):647–51.  https://doi.org/10.1001/archoto.2009.73. PubMed PMID: 19620584.CrossRefPubMedGoogle Scholar
  11. 11.
    Cohen SR, Eavey RD, Desmond MS, May BC. Endoscopy and tracheotomy in the neonatal period: a 10-year review, 1967–1976. Ann Otol Rhinol Laryngol. 1977;86(5 Pt 1):577–83. PubMed PMID: 911132.CrossRefGoogle Scholar
  12. 12.
    Dickson JM, Richter GT, Meinzen-Derr J, Rutter MJ, Thompson DM. Secondary airway lesions in infants with laryngomalacia. Ann Otol Rhinol Laryngol. 2009;118(1):37–43. PubMed PMID: 19244962.CrossRefGoogle Scholar
  13. 13.
    Krashin E, Ben-Ari J, Springer C, Derowe A, Avital A, Sivan Y. Synchronous airway lesions in laryngomalacia. Int J Pediatr Otorhinolaryngol. 2008;72(4):501–7.  https://doi.org/10.1016/j.ijporl.2008.01.002. Epub 2008 Mar 4. PubMed PMID: 18291536.CrossRefPubMedGoogle Scholar
  14. 14.
    Yuen HW, Tan HK, Balakrishnan A. Synchronous airway lesions and associated anomalies in children with laryngomalacia evaluated with rigid endoscopy. Int J Pediatr Otorhinolaryngol. 2006;70(10):1779–84. Epub 2006 Jul 10.CrossRefGoogle Scholar
  15. 15.
    Sesterhenn AM, Zimmermann AP, Bernhard M, Kussin A, Timmesfeld N, Stiller S, Wiegand S, Maier RF, Werner JA. Polysomnography outcomes following transoral CO2 laser microsurgery in pediatric patients with laryngomalacia. Int J Pediatr Otorhinolaryngol. 2009;73(10):1339–43.  https://doi.org/10.1016/j.ijporl.2009.06.002. Epub 2009 Jul 8. PubMed PMID: 19589607.CrossRefPubMedGoogle Scholar
  16. 16.
    Ayari S, Aubertin G, Girschig H, Van Den Abbeele T, Denoyelle F, Couloignier V, Mondain M. Management of laryngomalacia. Eur Ann Otorhinolaryngol Head Neck Dis. 2013;130(1):15–21.  https://doi.org/10.1016/j.anorl.2012.04.003. Epub 2012 Jul 24. Review. PubMed PMID: 22835508.CrossRefPubMedGoogle 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.CrossRefGoogle Scholar
  18. 18.
    Simons JP, Greenberg LL, Mehta DK, Fabio A, Maguire RC, Mandell DL. Laryngomalacia and swallowing function in children. Laryngoscope. 2016;126(2):478–84.CrossRefGoogle Scholar
  19. 19.
    Carter J, Rahbar R, Brigger M, Chan K, Cheng A, Daniel SJ, et al. International Pediatric ORL Group (IPOG) laryngomalacia consensus recommendations. Int J Pediatr Otorhinolaryngol. 2016;86:256–61.CrossRefGoogle Scholar
  20. 20.
    Velayutham P, Irace AL, Kawai K, Dodrill P, Perez J, Londahl M, et al. Silent aspiration: who is at risk? Laryngoscope. 2018;128(8):1952–7.CrossRefGoogle Scholar
  21. 21.
    Eustaquio M, Lee EN, Digoy GP. Feeding outcomes in infants after supraglottoplasty. Otolaryngol Head Neck Surg. 2011;145(5):818–22.CrossRefGoogle Scholar
  22. 22.
    Dobbie AM, White DR. Laryngomalacia. Pediatr Clin N Am. 2013;60(4):893–902.CrossRefGoogle Scholar
  23. 23.
    Arvedson JC. Management of pediatric dysphagia. Otolaryngol Clin N Am. 1998;31(3):453–76.CrossRefGoogle Scholar
  24. 24.
    Garritano FG, Carr MM. Characteristics of patients undergoing supraglottoplasty for laryngomalacia. Int J Pediatr Otorhinolaryngol. 2014;78(7):1095–100.CrossRefGoogle Scholar
  25. 25.
    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.  https://doi.org/10.1016/j.ijporl.2014.08.017. Epub 2014 Aug 21. Erratum in: Int J Pediatr Otorhinolaryngol. 2015 Dec;79(12):2489. PubMed PMID: 25194725.CrossRefPubMedGoogle Scholar
  26. 26.
    Ford DA. Safety considerations for laser surgery of the airway. AORN J. 2018;107(3):P15–6.  https://doi.org/10.1002/aorn.12108. PubMed PMID: 29486088.CrossRefPubMedGoogle Scholar
  27. 27.
    Paes ML. General anaesthesia for carbon dioxide laser surgery within the airway. A review. Br J Anaesth. 1987;59(12):1610–20. Review. PubMed PMID: 3122810.CrossRefGoogle Scholar
  28. 28.
    Zeitels SM, Burns JA, Akst LM, Hillman RE, Broadhurst MS, Anderson RR. Office-based and microlaryngeal applications of a fiber-based thulium laser. Ann Otol Rhinol Laryngol. 2006;115(12):891–6. PubMed PMID: 17214262.CrossRefGoogle Scholar
  29. 29.
    Ayari-Khalfallah S, Fuchsmann C, Froehlich P. Thulium laser in airway diseases in children. Curr Opin Otolaryngol Head Neck Surg. 2008;16(1):55–9.  https://doi.org/10.1097/MOO.0b013e3282f43419. PubMed PMID: 18197023.CrossRefPubMedGoogle Scholar
  30. 30.
    Ching HH, Spinner AG, Reeve NH, O-Lee TJ. A novel technique for unilateral supraglottoplasty. Int J Pediatr Otorhinolaryngol. 2018;104:150–4.  https://doi.org/10.1016/j.ijporl.2017.11.003. Epub 2017 Nov 6. PubMed PMID: 29287857.CrossRefPubMedGoogle Scholar
  31. 31.
    Douglas CM, Shafi A, Higgins G, Blackmore K, Wynne DM, Kubba H, Clement WA. Risk factors for failure of supraglottoplasty. Int J Pediatr Otorhinolaryngol. 2014;78(9):1485–8.  https://doi.org/10.1016/j.ijporl.2014.06.014. Epub 2014 Jun 20. PubMed PMID: 25005226.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  • Bethany R. Powers
    • 1
  • Bryn K. Olson-Greb
    • 2
  • Jessica Van Beek-King
    • 3
    Email author
  1. 1.Division of Otolaryngology-Head and Neck SurgeryUniversity of Wisconsin School of Medicine and Public HealthMadisonUSA
  2. 2.Department of Surgery, Division of Otolaryngology-Head and Neck SurgeryUniversity of Wisconsin School of Medicine and Public HealthMadisonUSA
  3. 3.Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, Section of Pediatric OtolaryngologyUniversity of Wisconsin School of Medicine and Public HealthMadisonUSA

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