Late-onset laryngomalacia: a variant of disease

To identify and describe the features of laryngomalacia (LM) in a cohort of older children, with the goal of providing an approach to diagnosis and management of these patients. Laryngomalacia is a common congenital disorder characterized by decreased laryngeal tone, supraglottic collapse, and stridor during inspiration and is rarely seen in older children. However, the presence of LM in this population may be obscured by related but uncommon clinical features.

Prospective collection and retrospective evaluation of older children with evidence of LM from 1998 to 2005.

Two tertiary pediatric institutions.

Prospective data collection of 239 patients with LM, including 222 with congenital LM and 17 diagnosed as having LM when they were older than 2 years and without a medical history of prior disease or symptoms-late-onset LM (mean age at onset, 6.6 years).

Supraglottoplasty.

Symptom improvement.

Patients with late-onset LM were classified into 3 categories according to their symptom complex; those presenting with feeding-disordered LM (n = 7; mean age at onset, 3.3 years), sleep-disordered LM (n = 7; mean age at onset, 6.3 years), and exercise-induced LM (n = 3; mean age at onset, 15 years). Stridor was rarely present except in patients with exercise-induced LM during strenuous activity. Profound arytenoid redundancy and prolapse was discovered in all patients during nasolaryngeal endoscopy. Typical anatomic features of congenital LM (shortened aryepiglottic folds or retroflexed epiglottis) were not discovered. No patient had a history of neuromuscular disease. Supra-arytenoid reduction (supraglottoplasty) led to clinical cure in all patients (mean duration of follow-up, 7.4 months). Prior adenotonsillectomies were performed in 5 patients with sleep-disordered LM. This did not improve symptoms, and these patients displayed evidence of LM as the source of obstruction.

Physicians should consider late-onset LM as a potential cause of feeding difficulties in toddlers, sleep apnea in children, and exercise intolerance in teenagers. As in infants with LM, supraglottoplasty improves late-onset disease.