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Secondary airway lesions in laryngomalacia: a different perspective
Hani A Rifai1, Marc Benoit, Hamdy El-Hakim
1Pediatric Otolaryngology, Division of Pediatric Surgery, Department of Surgery, The Stollery Children's Hospital & University of Alberta Hospitals, Edmonton, Alberta, Canada.
Insights
The prevalence of secondary airway lesions in children with laryngomalacia is lower than previously reported, especially after excluding confounding conditions. This study highlights the importance of careful patient selection in determining accurate SAL prevalence in laryngomalacia.
Area of Science:
- Pediatric Otolaryngology
- Respiratory Medicine
Background:
- Laryngomalacia (LM) is a common congenital condition affecting the upper airway.
- Secondary airway lesions (SALs) are sometimes associated with LM, but their prevalence is debated.
Purpose of the Study:
- To determine the prevalence of SALs in children diagnosed with LM.
- To investigate the association between LM and other airway pathologies.
Main Methods:
- A cross-sectional observational study was conducted at a tertiary care pediatric facility.
- 91 children diagnosed with LM, after excluding those with cardiac/large-vessel malformations, prematurity, or prior airway surgery, were included.
- Airway examinations included laryngoscopy and bronchoscopy.
Main Results:
- The prevalence of SALs in the studied LM cohort was 7.7%.
- Identified SALs included subglottic stenosis, tracheomalacia, bronchomalacia, and choanal atresia.
- Most patients with LM did not have associated SALs.
Conclusions:
- The prevalence of SALs in LM is lower than previously suggested when confounding factors are excluded.
- Higher reported figures may be due to selective cohorts or inclusion of patients with other airway pathologies.
- Careful diagnostic criteria and patient selection are crucial for accurate SAL prevalence estimation in LM.
Objective:
To document the prevalence of secondary airway lesions (SALs) among children with laryngomalacia (LM).
Study Design:
A cross-sectional observational study.
Setting:
Single practice in a tertiary care pediatric facility.
Subjects And Methods:
Patients diagnosed with LM were initially identified from a prospectively kept surgical database. Patients with cardiac/large-vessel malformations, prematurity, repeated or prolonged intubations, acute infections, or prior airway surgery were excluded. Only children who had a full examination of the airway were included. Other associated diagnoses along with demographics, surgical intervention, and type of LM were included.
Results:
Over an 8-year period, 1112 patients underwent laryngoscopy and bronchoscopy. A total of 108 consecutive cases were diagnosed with LM (78 primary diagnosis and 30 secondary diagnosis). After excluding 17 with disorders associated with large airway disease, 91 LM patients were included. The mean age was 553.23 days (ranging between 5 days and 15 years); 60 were boys and 31 were girls. The prevalence of SALs was 7.7% (95% confidence interval, 7.65-7.76; 7 children; 4 subglottic stenosis, 4 tracheomalacia, 1 bronchomalacia, and 1 choanal atresia). Fifty-nine patients underwent supraglottoplasties, while 1 patient had a tracheostomy.
Conclusions:
After accounting for conditions known to be associated with large airway lesions, the prevalence of SALs associated with laryngomalacia was much less than previously reported. The authors hypothesize that the upper-end figures are a reflection of highly select cohorts and the inclusion of patients with other pathology known to be associated with subglottic stenosis, tracheomalacia, and bronchomalacia and low thresholds for diagnosing mild subglottic stenosis.
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