Association Between Acid Reflux Medication and Supraglottoplasty in Infant Laryngomalacia

Acid suppression therapy is frequently administered to infants with laryngomalacia presenting with stridor despite limited evidence in the literature reporting its efficacy for this subset of patients.

To evaluate the frequency of supraglottoplasty in infants with nonsevere laryngomalacia treated with gastroesophageal reflux disease (GERD) medications.

This retrospective cohort study included infants younger than 6 months with a clinical diagnosis of nonsevere laryngomalacia initially managed with either watchful waiting or GERD medications. Patients were recruited from 2014 to 2023 to a pediatric otolaryngology airway clinic at a tertiary care pediatric hospital.

The primary outcome was the frequency of supraglottoplasty following nonsurgical management. Patients with nonsevere laryngomalacia were divided into 2 groups based on whether their laryngomalacia was managed with GERD medication therapy or observation alone. The aim was to assess the difference in supraglottoplasty rates between these 2 groups.

The medical records of 395 infants younger than 6 months (171 female, 224 male) with nonsevere laryngomalacia managed with observation after their initial otolaryngology evaluation were analyzed: observation (n = 320) and trial of GERD medications (n = 75). Baseline characteristics between the observation and GERD medication groups were similar. The overall supraglottoplasty rate was 4.1% (16/395), with a small increase in the use of surgical treatment between the observation and GERD medication cohorts (3.4% vs 6.7%; difference, -3.2% [95% CI, -10% to 3.6%]). The imprecision in the estimate prevents making a definitive conclusion regarding the observed difference.

This study found that rates of supraglottoplasty in infants with nonsevere laryngomalacia with GERD managed with GERD medications were similar to those without reflux managed with watchful waiting. Female sex and severity of laryngomalacia based on endoscopic examination were the best predictors of receipt of supraglottoplasty after a period of watchful waiting.