Factors associated with the morphological type of laryngomalacia and prognostic value for surgical outcomes.

Importance: The classic presentation of laryngomalacia (LM) is stridor, but alternate presentations include snoring and/or sleep-disordered breathing (S-SDB) and swallowing dysfunction (SWD). Several classification schemes have been developed for LM, but to our knowledge, none have been successfully investigated as to the ability to predict parameters of patients with LM or surgical outcomes.

Objective: To compare parameters of patients with different types of LM and determine whether the type has prognostic value for surgical outcomes and to explore if any variable predicts or correlates with the type of LM.

Design, Setting, And Participants: Retrospective case series from a single tertiary pediatric otolaryngology practice. Patients with LM treated with supraglottoplasty (SGP) were eligible. We included patients with confirmed diagnosis of LM who underwent a cold steel SGP and had complete resolution of symptoms or at least 3 months of follow-up, with complete data.

Interventions: Investigations and treatment of the patients were followed as per routine practice for the senior author (H.E.).

Main Outcomes And Measures: Demographics, type of LM, secondary airway lesions, secondary diagnosis, primary presentation (stridor, S-SDB, SWD), and outcome of SGP were collected. Correlation and multiple regression analysis were performed.

Results: A total of 125 children with LM who underwent SGP for LM were identified. Of these procedures, 119 were cold steel technique, and 8 were repeated procedures. Ninety patients met criteria and were included (mean [SD] age, 1.46 [2.34] years [range, <6 months to 15 years]; male to female ratio, 1.9:1). The primary presentation was stridor in 66 children, S-SDB in 14, and SWD in 10. The type of LM correlated significantly with age (-0.9), and presentation (0.49). Sex and presence of neurological diagnosis (correlation coefficient [SE], -0.317 [0.136], P = .02; and -0.968 [0.361], P <.01, respectively) were associated with outcome. Presentation and obesity were associated with type of LM (-0.251 [0.071], P <.001; and 0.593 [0.296], P = .048, respectively).

Conclusions And Relevance: Type of LM varies by age and primary presentation. Outcome of management is poorer for males and in the presence of a neurological diagnosis. The findings of the present study may help in counseling parents on the risks and benefits of SGP surgery as well as on expected outcomes postoperatively. Further work is required in validating an existing classification scheme for LM or developing a new, validated classification system with may be used for future outcomes research.