Etiological factors, best treatment and types of laryngomalacia, a retrospective study.

Heijden, M. van der (Martijn) (2014) Etiological factors, best treatment and types of laryngomalacia, a retrospective study. thesis, Medicine.

Text HeijdenvanderM.pdf Restricted to Registered users only Download (513kB)

Abstract

Introduction: Laryngomalacia is the most common cause of stridor in newborn infants. Laryngomalacia is a dynamic change of the upper airway based on abnormally pliable supraglottic structures, which causes upper airway obstruction. In most cases laryngomalacia presents as a mild disease, which can be treated with a wait-and-see policy. Up to 20% of patients present with severe laryngomalacia and may need endoscopic surgery, so called supraglottoplasty. Different co-morbidities have been described to influence severity of disease, such as synchronous airway lesions (SALs) and cardial, neurologic and syndromal/genetic disorders. The primary goal is to determine whether supraglottoplasty has better outcome results than wait-and-see and to see how co-morbidities influence outcome. Besides all this, several classification systems have been published. Until now no classification is widely accepted and applied. Our secondary goal is to provide a simple and complete classification system. This could facilitate communication amongst professionals and provide better health care. Material and methods: A retrospective study of all patients with laryngomalacia under age 5 at time of diagnosis was performed. Photo and video documentation was used to confirm diagnosis, and if not possible patients were excluded. Electronic and paper charts were reviewed for: gender, sex, gestational age, birth weight, symptoms, co-morbidity, date of endoscopy, severity and type of laryngomalacia, performed treatment, surgical technique and follow-up data. For the classification system our data results have been compared with available articles in literature. Results: A total of 89 patients were included. Demographic data corresponded with literature. Supraglottoplasty significantly shows faster complete improvement of laryngomalacia than wait-and-see (5 weeks vs. 29, p=0.026). SALs were present in 40.4% of patients and were associated with extended length of laryngomalacia (38.5 weeks vs. 14.5, p=0.043). The most frequent SAL was tracheamalacia (39%). Co-morbidity was present in 67.4% of patients and was associated with extended length of disease (31 symptomatic weeks vs. 15, p=0.116). Although laryngomalacia is a dynamic change in supraglottic structures, most classification systems use static findings for grading. In our series, only 3 different dynamic changes have been observed. Conclusion: Supraglottoplasty is a safe and effective treatment for patients with severe laryngomalacia. SALs and co-morbidities are frequently found in patients with laryngomalacia and are of negative influence on long term outcomes. Our proposal of a new classification system with three types should facilitate communication amongst professionals. This is a step towards a better treatment algorithm and better health care for laryngomalacia.

Item Type:	Thesis (Thesis)
Supervisor name:	Halmos, Dr. G.B.
Faculty:	Medical Sciences
Date Deposited:	25 Jun 2020 10:51
Last Modified:	25 Jun 2020 10:51
URI:	https://umcg.studenttheses.ub.rug.nl/id/eprint/1241

Actions (login required)

View Item