From the Guidelines
Laryngomalacia should be treated with supraglottoplasty in cases of severe symptoms, such as significant breathing difficulty, poor weight gain, feeding problems, or sleep apnea, as it has been shown to improve airflow and reduce symptoms. This condition is characterized by the collapse of the soft tissues of the larynx during inhalation, causing noisy breathing in infants. According to the American Thoracic Society clinical practice guideline 1, sleep-dependent laryngomalacia is increasingly recognized as a cause of persistent obstructive sleep apnea (OSA) in children. The guideline recommends supraglottoplasty as a treatment option for sleep-dependent laryngomalacia, which involves the division of shortened aryepiglottic folds and trimming of redundant supra-arytenoidal mucosa.
Key Points to Consider
- Laryngomalacia is the most common cause of stridor in babies, typically appearing within the first few weeks of life 1.
- Most cases of laryngomalacia are mild and resolve on their own by 18-24 months of age as the child's airway structures mature and strengthen.
- Parents should position infants with laryngomalacia in an upright or slightly elevated position during feeding and sleeping to reduce symptoms.
- For mild cases, no specific medication or treatment is needed beyond watchful waiting and reassurance.
- However, if symptoms are severe, surgical intervention called supraglottoplasty may be necessary to improve airflow and reduce symptoms 1.
Treatment Outcomes
Studies have shown that supraglottoplasty can improve PSG parameters, including reduction in apnea-hypopnea index (AHI) and improvement in minimal oxygen saturation during sleep 1. However, it is essential to note that the contribution of supraglottoplasty to the overall improvement in symptoms can be difficult to measure, as children with persistent OSA often undergo multiple procedures to address multilevel upper airway obstruction. Supraglottoplasty is a viable treatment option for severe cases of laryngomalacia, and its benefits should be weighed against the potential risks and complications, such as respiratory distress, postoperative bleeding, and aspiration.
From the Research
Definition and Causes of Laryngomalacia
- Laryngomalacia is a well-described cause of newborn stridor, resulting from upper airway obstruction caused by collapse of supraglottic tissue into the airway 2, 3.
- The spectrum of disease presentation, progression, and outcomes is varied, with some infants experiencing inconsequential stridor and others developing feeding symptoms or severe complications of airway obstruction 2, 4.
Symptoms and Diagnosis
- Laryngomalacia is the most common cause of stridor in neonates and infants, often associated with feeding difficulties and inspiratory stridor 5, 6.
- A definitive diagnosis can generally be made with flexible fiberoptic laryngoscopy 5.
- Identifying symptoms and patient factors that influence disease severity helps predict outcomes, including the presence of gastroesophageal reflux disease (GERD) and laryngopharyngeal reflux (LPR) 2, 4.
Treatment and Management
- Most cases of laryngomalacia are mild and self-resolve, but severe symptoms require investigation and intervention, including medical treatment with antireflux medications and surgical treatment with supraglottoplasty 2, 3.
- Supraglottoplasty is the preferred surgical treatment, reserved for severe cases, with excellent results and low rates of complications in otherwise healthy children 5, 6.
- Patients with significant comorbidities, such as neurologic conditions and syndromes, may require additional interventions and have a higher risk of complications or persistent symptoms after supraglottoplasty 5, 6.