Treatment outcome of supraglottoplasty vs. wait-and-see policy in patients with laryngomalacia

Abstract

In most cases, laryngomalacia presents as a mild disease, and the symptoms resolve after wait-and-see policy. Up to 20 % of patients present with severe laryngomalacia and may require surgery (i.e. supraglottoplasty); however, the indication for surgery is not firmly established yet. The goal of this study is to determine whether supraglottoplasty results in a better outcome than wait-and-see and to investigate how different comorbidities influence outcome. A retrospective study of pediatric cases of in a tertiary referral center was performed. Photo and video documentation was available and revised in all cases. Electronic and paper charts were reviewed for the following variables: gender, sex, gestational age, birth weight, symptoms, comorbidity, date of endoscopy, severity and type of laryngomalacia, treatment modality and technique and follow-up data and a total 89 patients were included. Supraglottoplasty was found to lead to significantly faster complete improvement of laryngomalacia than wait-and-see policy (5 weeks vs. 29, p = 0.026). Synchronous airway lesions (SALs) were present in 40.4 % of patients and were associated with prolonged symptoms of laryngomalacia (38.5 weeks vs. 14.5, p = 0.043). Supraglottoplasty is safe and effective in treatment of severe laryngomalacia. SALs and comorbidities are frequently found in patients with laryngomalacia and are responsible for longer onset of complaints.Electronic supplementary materialThe online version of this article (doi:10.1007/s00405-016-3943-3) contains supplementary material, which is available to authorized users.

Surgical Intervention for Laryngomalacia: Age-Related Differences in Postoperative Sequelae

“…17 Additionally, supraglottoplasty in Dutch children with LM was found to result in complete resolution of symptoms by 5 weeks compared to 29 weeks in those patients with LM who underwent observation. 18 Despite numerous analyses composed of institutional retrospective cohorts and single-surgeon reports, there has been limited research effort toward evaluating the perioperative sequelae of children undergoing surgery for LM from a national perspective.…”

Impact of Infant Supraglottoplasty on Quality of Life

“…Long-term data could have assessed for normalizations of QOL outcomes with the general population; however, literature has shown that laryngomalacia typically takes months to resolve without supraglottoplasty whereas complete symptomatic improvement with supraglottoplasty occurs over the course of weeks. 38 It stands to reason that as our data show improvement in QOL along a timeline similar to functional improvements following supraglottoplasty, the improvement in QOL is likely secondary to undergoing supraglottoplasty rather than bias or the natural history of the disease. The ITQOL-SF47 itself is limited in that it relies on parental perceptions and not actual patient-reported or objective information.…”

Laryngomalacia: is there an evidence base for management?

“…A similar retrospective study, of 89 patients, compared outcomes of supraglottoplasty with those of a wait-and-see policy, and considered the influence of co-morbidities 20 . Unsurprisingly, surgery was associated with a statistically significant faster resolution of symptoms than conservative management (5 weeks vs 29 weeks; p = 0.026), and synchronous airway lesions further prolonged symptoms.…”

“…Unsurprisingly, surgery was associated with a statistically significant faster resolution of symptoms than conservative management (5 weeks vs 29 weeks; p = 0.026), and synchronous airway lesions further prolonged symptoms. The authors found supraglottoplasty to be safe and effective in severe laryngomalacia, but did concede that ‘the indication for surgery is not firmly established yet’ 20 …”