Congenital laryngomalacia: symptom duration and need for surgical intervention

We undertook to characterize the natural course and duration of stridor and other symptoms associated with laryngomalacia and determine the need for surgical intervention.

A retrospective observational study was performed at a tertiary children's hospital of 120 consecutive cases of congenital laryngomalacia diagnosed and treated by the senior author between July 2005 and June 2009. The patients' symptoms, associated symptoms, and required interventions were recorded.

In 115 cases that were managed without surgery, stridor resolved at a mean patient age of 7.6 months. Five patients (4.2%) required supraglottoplasty to resolve their airway obstruction. The patients who required surgery presented emergently to the hospital 80% of the time, and at a younger mean age (45 days) than did patients who did not require surgery (95 days; p = 0.13); these findings suggest the severe nature of their symptoms. Presenting symptoms of dyspnea or accessory muscle use, feeding difficulties, apnea, cyanosis, oxygen desaturation, and failure to thrive were significantly associated with the requirement for operative intervention (all p values less than 0.02). Nonoperative management included placement of a nasogastric tube due to aspiration in 3 patients.

The stridor resolved at an average age of 7.6 months of age in patients with laryngomalacia managed without surgery. A young age at presentation and emergent evaluation in the hospital are associated with a higher degree of symptom severity and a higher rate of surgical intervention. Surgical intervention was necessary to treat laryngomalacia in 4.2% of patients in this study population.