From the Guidelines
Laryngomalacia, a condition characterized by soft and pliable cartilage of the larynx, has several key risk factors that contribute to its development, including prematurity, male gender, and the presence of other congenital anomalies. The primary risk factors for laryngomalacia can be identified as follows:
- Prematurity: Infants born prematurely are at a higher risk of developing laryngomalacia due to the underdevelopment of their laryngeal structures 1.
- Male gender: Males are more commonly affected by laryngomalacia than females, suggesting a possible genetic or hormonal component to the condition.
- Congenital anomalies: The presence of other congenital anomalies, particularly those affecting the airway or neurological system, increases the risk of laryngomalacia.
- Gastroesophageal reflux disease (GERD): GERD is strongly associated with laryngomalacia, either as a contributing factor or a complication, and can exacerbate symptoms 1. Additional risk factors that may contribute to the development or severity of laryngomalacia include:
- Neurological conditions: Conditions that affect muscle tone and coordination, such as hypotonia or cerebral palsy, can increase the risk of developing more severe symptoms.
- Genetic syndromes: Certain genetic syndromes, such as Down syndrome, CHARGE syndrome, and DiGeorge syndrome, are associated with higher rates of laryngomalacia.
- Anatomical factors: Anatomical abnormalities, such as micrognathia (small jaw) or macroglossia (enlarged tongue), can exacerbate symptoms by causing posterior displacement of the tongue and increased negative pressure during inspiration. It is essential to recognize these risk factors, as they may influence the severity of laryngomalacia and guide management decisions, particularly in determining which infants might require surgical intervention versus those who can be managed conservatively 1.
From the Research
Risk Factors for Laryngomalacia
The risk factors for laryngomalacia include:
- Low APGAR scores 2
- Low resting SAO2 level at time of presentation 2
- Presence of a secondary airway lesion 2
- Gastroesophageal reflux disease (GERD) 2, 3, 4
- Laryngopharyngeal reflux (LPR) 2
- Neurologic disease 2
- Congenital heart disease 2
- Genetic syndrome or anomaly 2
- Presence of comorbidities, which can affect surgical outcomes 2, 4
Disease Severity and Outcomes
Factors that influence disease severity and outcomes include:
- Presence of medical co-morbidities, such as GERD/LPR, neurologic disease, congenital heart disease, or a genetic syndrome 2
- Presence of multiple medical co-morbidities, which can increase the likelihood of requiring revision supraglottoplasty or tracheostomy 2
- Severity of symptoms, with severe disease requiring surgery 5, 2, 6, 4