Laryngomalacia: factors that influence disease severity and outcomes of management

Laryngomalacia is a well described cause of newborn stridor. The spectrum of disease presentation, progression, and outcomes is varied. Some infants will have inconsequential stridor where others will develop feeding symptoms or even severe or life-threatening complications of airway obstruction. The purpose of this review is to identify factors that influence disease severity and outcomes.

Review of the current literature and a prospectively collected database shows that patient factors that influence disease severity include APGAR scores, resting SAO2 level at time of presentation, and the presence of a secondary airway lesion. Gastroesophageal reflux disease (GERD) and laryngopharyngeal reflux (LPR) contribute to feeding symptoms. Medical co-morbidities of GERD/LPR, neurologic disease, congenital heart disease, a genetic syndrome, or anomaly also contribute to disease severity and additively affect surgical outcomes. Those with severe disease requiring surgery who have GERD/LPR and one additional co-morbidity are more likely to require revision supraglottoplasty. Those with three medical co-morbidities are more likely to require tracheostomy.

Most with laryngomalacia will have mild to moderate symptoms and not require surgical intervention. Those with GERD/LPR have symptoms improvement from acid suppression therapy. Those with severe enough disease to require supraglottoplasty will have minimal complications and good outcomes if multiple medical co-morbidities are not present. Those with multiple medical co-morbidities could be offered supraglottoplasty as the first intervention but counseled that tracheostomy may be required.