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Pharyngomalacia in Neonates: The Missed Issue
1Pediatric Interventional Pulmonology Division, Department of Pediatrics, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran.
Insights
Pharyngomalacia (PM), a cause of noisy breathing in infants, is often overlooked. This study highlights the importance of pharyngeal investigation in neonates to improve diagnosis and management of this condition.
Area of Science:
- Pediatrics
- Otolaryngology
- Respiratory Medicine
Background:
- Airway malacia (AM) involves weakness in airway structures, leading to collapse during respiration.
- Pharyngomalacia (PM), or concentric pharyngeal wall inspiratory collapse (PWIC), affects the pharynx and is frequently missed in neonates with noisy breathing.
- Lack of awareness and diagnostic experience contribute to underdiagnosis of PM.
Purpose of the Study:
- To evaluate nasopharyngeal investigation in neonates presenting with noisy breathing.
- To determine the frequency of PM in this population.
- To propose indications for intervention in neonates with PM.
Main Methods:
- A retrospective study analyzed 100 neonates with noisy breathing from September 2015 to October 2018.
- Thin fiberoptic bronchoscopy was used for upper airway evaluation in conscious, unsedated neonates.
- Data on PM diagnosis, severity, location, and synchronous airway abnormalities were collected.
Main Results:
- PM was diagnosed in 38% of neonates (38/100), with a higher prevalence in males (71%).
- Inspiratory stridor was the most common symptom (92.1%).
- PM was frequently associated with other airway abnormalities, most commonly laryngomalacia (34.3%), and often involved the velopharynx (39.4%).
Conclusions:
- PM is a significant cause of noisy breathing in neonates and can coexist with other airway malacias, complicating diagnosis and management.
- Inadequate experience and facilities hinder accurate diagnosis and effective treatment of PM.
- Pharyngeal investigation is a critical, often missed, component of the diagnostic workup for neonates with noisy breathing.
Abstract:
Background: Airway malacia (AM) is a weakness of the airway's frameworks making them collapsible during the respiratory phases. Although the larynx, trachea, and bronchus are the usual sites for malacia to occur, there is another important type of malacia that involves the pharynx. Pharyngomalacia (PM) or concentric pharyngeal wall inspiratory collapse (PWIC) is mostly missed during bronchoscopic evaluations in the neonates with noisy breathing because people are not aware of this condition. Methods: This study aimed to evaluate the nasopharyngeal investigation among neonates suffering from noisy breathing. The retrospective study was undertaken to assess the frequency of PM and to propose indications for intervention in 100 neonates with noisy breathing. A thin fiberoptic bronchoscope was used to evaluate the upper airways under conscious status without any sedation in the neonates. Results: A total of 100 neonates with noisy breathing from September 2015 to October 2018 were retrospectively analyzed. The most common presenting symptom was inspiratory stridor which was observed in 35 (92.1%) of cases. PM was diagnosed in 38 neonates (38%) including 27 (71%) males and 13 (29%) females. Seventeen (44.7%) cases had mild, 11 (28.9%) cases had moderate, and 10 (26.4%) cases had a severe type of PM. PM was more prominent at the velopharynx level in 15 (39.4%) cases, and it was accompanied by up to six synchronous airway abnormalities. The most frequent synchronous airway abnormality was laryngomalacia in 13 (34.3%). Conclusion: PM is one of the causes of noisy breathing in infants. Since PM can be accompanied by the presence of other types of airway malacia, the issue becomes more complicated. On the other hand, lack of experience and facilities are two main causes for the accurate diagnosis and effective management among neonates. This study indicates that the investigation of pharynx is a missed part of the many workups that are used to diagnose the site of involvement in neonates with noisy breathing.
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