Lower airway anomalies in infants with laryngomalacia

Effect of Supraglottoplasty on congenital tracheomalacia

PURPOSE

Evaluation of the effect of supraglottoplasty on co-existing tracheomalacia in pediatric patients with congenital laryngotracheomalacia to establish the venturi effect in vivo.

METHODS

A prospective interventional study was conducted in a tertiary care hospital from 2020 to 2024. All consecutive pediatric patients undergoing supraglottoplasty for congenital laryngomalacia, with co-existing tracheomalacia on pre-operative bronchoscopic assessment were included and were assessed for change in severity of tracheomalacia by bronchoscopy and clinical parameters post-surgery as a comparison to the preoperative period.

RESULTS

Twenty-eight patients including sixteen boys and twelve girls aged 1-30 months underwent supraglottoplasty. Statistically significant reduction in tracheal collapse was noted in all twenty-eight patients post-surgery on bronchoscopic evaluation (mean reduction by 41.45 ± 9.72 %). Clinically significant improvement was seen in terms of severity of stridor, frequency of hospitalization, apparent life-threatening events, z score for weight for age and parental perception of resolution of symptoms of their ward.

CONCLUSION

Supraglottoplasty for correction of laryngomalacia results in significant improvement in co-existing tracheomalacia. Associated medical comorbidities were not found to affect the positive outcome. Supraglottoplasty being a simple surgery with insignificant complication rate and very high success rate may be considered as the first line of surgical intervention in severely symptomatic pediatric patients with laryngotracheomalacia.

Characteristics of Patients with Laryngomalacia: A Tertiary Referral Center Experience of 106 Cases

Laryngomalacia (LM) is the most common airway congenital anomaly and the main cause of stridor in infants. Some patients with severe airway symptoms or with feeding difficulties require surgical intervention. Synchronous airway lesions (SALs) may influence the severity and course of the disease. This study aimed to determine the prevalence of various types of LM and SALs and their influence on surgical intervention decisions and feeding difficulties. Moreover, the study focused on the interrelations between SALs and the type of LM or the presence of feeding difficulties. A retrospective analysis of 106 pediatric patients revealed a significant relationship between type 2 LM and the necessity of surgical treatment. We also found a significant effect of LM type 2 on feeding difficulty. Type 1 LM is significantly more characteristic in premature children. Among different comorbidities, SALs are suspected of modification of the course and severity of LM. This study did not find a significant effect of SALs on the incidence of supraglottoplasty or feeding difficulty.

Etiology, Clinical Profile, Evaluation, and Management of Stridor in Children

OBJECTIVE

To evaluate various causes of pediatric stridor and their management among admitted patients in last 2 y.

METHODS

Retrospective study of 67 stridor cases in pediatric age group (from birth to 18 y), admitted to the Department of Pediatrics and ENT (Ear, Nose and Throat) from May 2018 to April 2020 were included in the study. Data were obtained from medical records regarding age, gender, clinical presentation, and management.

RESULTS

Out of 67 cases of pediatric stridor, 28.3% were infants, 50.7% were between 1 to 5 y, while 20.9% were between 5 to 18 y. Foreign body trachea (FB) was the most common (38.8%) cause of stridor. The commonest cause of stridor among infants was laryngomalacia (47.4%) while FB trachea (55.9%) was the commonest cause among 1 to 5 y age group. In age group between 5 to 18 y, peritonsillar abscess and bacterial tracheitis (21.4% each) were found to be the most common. Primary management with securing of airways were done in all cases. Curative treatment was provided according to the underlying pathology. Eight patients (11.9%) required tracheostomy to bypass airway obstruction. There was no mortality in the present study population.

CONCLUSION

Pediatric stridor management is a teamwork between ENT surgeons, pediatricians, and anaesthetists. Management starts with suspicion from history followed by clinical and radiological evaluation. Securing airway is of utmost importance and precise management of cause is carried out later.

Types of laryngomalacia in children: interrelationship between clinical course and comorbid conditions

The aim of this study was to: (1) find out whether laryngomalacia (LM) types are related to clinical course; (2) which patients with LM are at higher risk of other airway malacia [tracheomalacia (TM) and/or bronchomalacia (BM)]; and (3) evaluate the prevalence of LM in our region. Patients with established LM diagnosis and complete clinical and endoscopy records were enrolled. They were classified into different LM types according to classification based on the side of supraglottic obstruction. One hundred ten children were included. The most common LM appearance was type I—58 children, followed by combine types (I + II and I + III)—38. The other airway malacia were found in 47 patients: TM in 31, BM in 10, and TM with BM in 6. Other comorbidities (cardiac, neurological, and genetic disorders) were identified in 30 children. Patients with combine types of LM differ from those with single type of LM in terms of prematurity (13 vs 31 %, p = 0.04) and higher weight on the examination day (p = 0.006). Patients with other airway malacia differ from children with isolated LM in terms of prematurity (40 vs 13 %, p = 0.008), comorbidities (38 vs 19 %, p = 0.024), and lower weight on the examination day (p = 0.014). The prevalence of clinically relevant LM was one in 2600–3100 newborns. Clinical course of LM cannot be anticipated on the basis of solely endoscopic evaluation of the larynx. Comorbidities and prematurity increase the risk of other airway malacia. The prevalence of LM is relatively high in the middle-south part of Poland.

Treatment outcome of supraglottoplasty vs. wait-and-see policy in patients with laryngomalacia

In most cases, laryngomalacia presents as a mild disease, and the symptoms resolve after wait-and-see policy. Up to 20 % of patients present with severe laryngomalacia and may require surgery (i.e. supraglottoplasty); however, the indication for surgery is not firmly established yet. The goal of this study is to determine whether supraglottoplasty results in a better outcome than wait-and-see and to investigate how different comorbidities influence outcome. A retrospective study of pediatric cases of in a tertiary referral center was performed. Photo and video documentation was available and revised in all cases. Electronic and paper charts were reviewed for the following variables: gender, sex, gestational age, birth weight, symptoms, comorbidity, date of endoscopy, severity and type of laryngomalacia, treatment modality and technique and follow-up data and a total 89 patients were included. Supraglottoplasty was found to lead to significantly faster complete improvement of laryngomalacia than wait-and-see policy (5 weeks vs. 29, p = 0.026). Synchronous airway lesions (SALs) were present in 40.4 % of patients and were associated with prolonged symptoms of laryngomalacia (38.5 weeks vs. 14.5, p = 0.043). Supraglottoplasty is safe and effective in treatment of severe laryngomalacia. SALs and comorbidities are frequently found in patients with laryngomalacia and are responsible for longer onset of complaints.

Indications and outcome of flexible bronchoscopy in neonates

OBJECTIVE

To analyse the indications, safety and outcome of flexible fiberoptic bronchoscopy (FOB) in neonates.

METHODS

This descriptive study was conducted in Level III neonatal unit (ICH, Chennai) and included 84 neonates with various respiratory problems admitted over a 3 y period.

RESULTS

The indications included stridor (18%), persistent radiological abnormalities (44%), unexplained wheeze/respiratory distress (21%) and others (17%). The mean age and weight were 25 d and 2.82 kg respectively. Bronchoscopy detected various anomalies like upper airway anomalies (10.7%), lower airway malacia (21%), synchronous airway malacias (19%) and miscellaneous anatomical abnormalities (18%). Bronchoalveolar lavage was done in 62% with microbiological yield in 54% cases.FOB helped in the revision of diagnosis in 57%. Resolution of atelectasis was observed in 13.5% cases. Except for transient hypoxemia in 2 neonates, no other complication was encountered.

CONCLUSIONS

Flexible bronchoscopy is safe and useful both as diagnostic and therapeutic tool in neonates with respiratory problems.

Flexible bronchoscopy as a valuable tool in the evaluation of infants with stridor

The aim is to determine clinical characteristics, flexible bronchoscopy (FB) findings including associated airway abnormalities and other conditions, treatment modalities and long term follow-up of children with congenital stridor. Medical records of children, who underwent FB for the evaluation of stridor between 1 January 2004 and 31 December 2009 were retrospectively reviewed. Demographic characteristics, symptoms and physical examination findings at presentation, FB findings, follow-up data including the time to resolution of symptoms and treatment modalities, presence of associated conditions were assessed. 109 children were enrolled to the study. Laryngomalacia was the most common etiology for stridor. Laryngomalacia was isolated in 37 patients and 54 patients had secondary airway lesions (SALs). Diagnoses other than laryngomalacia such as subglottic hemangioma, subglottic web, isolated tracheomalacia were found in 18 patients. In 90 % of patients, stridor resolved before 3 years of age without any surgical intervention and there was no significant difference in terms of the persistence of stridor between patients with isolated laryngomalacia and associated SALs. Duration of stridor was significantly longer in both patients with neurological abnormalities and reflux symptoms. Surgical procedure was performed in 19 of the patients. There is a high incidence of SALs in patients with laryngomalacia. FB is helpful for identifying anomalies requiring surgical treatment.