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Mnatsakanian A, John J, Costeloe A, Minutello K, Shifman H, Thottam P, Haupert M. Post-operative safety of pediatric supraglottoplasty: Is post-operative admission necessary? Am J Otolaryngol 2024; 45:104171. [PMID: 38101128 DOI: 10.1016/j.amjoto.2023.104171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Accepted: 12/05/2023] [Indexed: 12/17/2023]
Abstract
OBJECTIVES The purpose of this study was to determine the incidence of adverse events in the first 48 h (acute) 14 days (subacute) in post supraglottoplasty pediatric patients. A secondary aim was to determine if postoperative hospital admission after supraglottoplasty in pediatric patients is necessary. METHODS This study was a retrospective review of pediatric patients who underwent supraglottoplasty at a tertiary care center. Data were obtained from January 2017-December 2020, totaling 107 patients. Pediatric patients who underwent supraglottoplasty were included in the study. Information regarding patients' demographics, length of postoperative hospital stay, comorbid conditions, unit of hospital admission, intraoperative and postoperative adverse events, and readmission within the first 14 days was gathered and analyzed. RESULTS The incidence of postoperative adverse events for all subjects after supraglottoplasty was 5.7 % (N = 6). The most common postoperative complications were respiratory distress (N = 2), followed by substernal retractions, stridor, and decreased oral intake (N = 1). There was no statistically significant increased incidence in any group of patients, regardless of their unit of stay post-operatively (p = 0.39). CONCLUSIONS Supraglottoplasty is a safe surgical option for patients with severe laryngomalacia. While each patient's care is individualized, we demonstrate that post-operative hospital admission is not necessary for healthy children undergoing supraglottoplasty. LEVEL OF EVIDENCE III - This is a retrospective chart review.
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Affiliation(s)
- Ani Mnatsakanian
- Department of Otolaryngology - Head and Neck Surgery, Ascension Macomb-Oakland Hospital, Madison Heights, MI, USA
| | - Jithin John
- Department of Otolaryngology - Head and Neck Surgery, Detroit Medical Center, Detroit, MI, USA
| | - Anya Costeloe
- Department of Otolaryngology - Head and Neck Surgery, Ascension Macomb-Oakland Hospital, Madison Heights, MI, USA
| | - Katrina Minutello
- Department of Otolaryngology-Head and Neck Surgery, McLaren Oakland Hospital, Pontiac, MI, USA
| | - Holly Shifman
- Department of Otolaryngology - Head and Neck Surgery, Detroit Medical Center, Detroit, MI, USA
| | - Prasad Thottam
- Beaumont Hospital, Royal Oak, MI, USA; Michigan Pediatric Ear Nose and Throat Associates, West Bloomfield Township, MI, USA
| | - Michael Haupert
- Beaumont Hospital, Royal Oak, MI, USA; Michigan Pediatric Ear Nose and Throat Associates, West Bloomfield Township, MI, USA.
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刘 平, 林 宗, 沈 翎, 杨 中. [New progress in diagnosis and treatment of congenital laryngomalacia in infants]. LIN CHUANG ER BI YAN HOU TOU JING WAI KE ZA ZHI = JOURNAL OF CLINICAL OTORHINOLARYNGOLOGY, HEAD, AND NECK SURGERY 2023; 37:982-985. [PMID: 38114317 PMCID: PMC10985691 DOI: 10.13201/j.issn.2096-7993.2023.12.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Indexed: 12/21/2023]
Abstract
Congenital laryngomalacia is the most common disease causing laryngeal stridor in infants. The pathogenesis has not yet been clearly concluded. It may be related to abnormal development of laryngeal cartilage anatomical structure, neuromuscular dysfunction, gastroesophageal and laryngeal reflux disease, etc. The typical manifestations of the disease are inspiratory laryngeal stridor and feeding difficulties, which can be divided into mild, moderate and severe according to the severity of symptoms. The diagnosis is mainly based on clinical symptoms, signs and endoscopy, among which endoscopy is an important diagnostic basis. The treatment of laryngomalacia depends on the severity of symptoms. Mild and some moderate congenital laryngomalacia children can be relieved by conservative treatment, and severe and some moderate congenital laryngomalacia children should be treated by surgery. Supraglottic plasty is the main surgical method, which can effectively improve the symptoms of laryngeal stridor, dyspnea, feeding difficulties and growth retardation in most children, and the surgical effect is good.
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Affiliation(s)
- 平凡 刘
- 福建省福州儿童医院耳鼻咽喉科(福州,350000)Department of Otolaryngology, Fuzhou Children's Hospital of Fujian Province, Fuzhou, 350000, China
| | - 宗通 林
- 福建省福州儿童医院耳鼻咽喉科(福州,350000)Department of Otolaryngology, Fuzhou Children's Hospital of Fujian Province, Fuzhou, 350000, China
| | - 翎 沈
- 福建省福州儿童医院耳鼻咽喉科(福州,350000)Department of Otolaryngology, Fuzhou Children's Hospital of Fujian Province, Fuzhou, 350000, China
| | - 中婕 杨
- 福建省福州儿童医院耳鼻咽喉科(福州,350000)Department of Otolaryngology, Fuzhou Children's Hospital of Fujian Province, Fuzhou, 350000, China
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Arbona DV, Pratt C, Tearney C, Istvan S. A case of epiglottic entrapment in a cat. Vet Med Sci 2023; 9:1953-1958. [PMID: 37465985 PMCID: PMC10508545 DOI: 10.1002/vms3.1211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 04/25/2023] [Accepted: 07/06/2023] [Indexed: 07/20/2023] Open
Abstract
OBJECTIVE The objective of this study was to describe a case of epiglottic entrapment in a cat. CASE SUMMARY A 5-month-old male neutered Russian Blue cat was evaluated for progressive stertorous upper airway sounds, acute onset vestibulopathy and abnormal laryngeal anatomy. Endotracheal intubation was only able to be achieved using videoscopic guidance and identified concern for severe nasopharyngeal stenosis. A computerized tomography scan revealed otitis interna, narrowed nasopharynx and no definitive cause for the stertorous breathing. The cat recovered very slowly from anaesthesia due to concern for airway obstruction following extubation. It was discharged the following day and then passed away at home 2 weeks later. Necropsy revealed that the epiglottis was obscured by 2 cm of redundant mucosal tissue extending from the base of the tongue to the larynx resulting in epiglottic entrapment. Also noted was chronic, severe otitis interna and externa. Upper airway obstruction is suspected to be the cause of sudden death. NEW OR UNIQUE INFORMATION To the authors' knowledge, this is the first report of these oropharyngeal anatomic abnormalities in a cat.
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Affiliation(s)
| | - Chap Pratt
- Colorado Animal Specialty and EmergencyCritical CareBoulderColoradoUSA
| | - Caitlin Tearney
- Veterinary Medical Center: AnesthesiaUniversity of Minnesota College of Veterinary MedicineSt. PaulMinnesotaUSA
| | - Stephanie Istvan
- Veterinary Specialty Hospital – Sorrento ValleySan DiegoCaliforniaUSA
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Kang ES, Turkdogan S, Yeung JC. Disposition to pediatric intensive care unit post supraglottoplasty repair: a systematic review. J Otolaryngol Head Neck Surg 2023; 52:35. [PMID: 37106398 PMCID: PMC10136380 DOI: 10.1186/s40463-023-00622-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 01/28/2023] [Indexed: 04/29/2023] Open
Abstract
BACKGROUND Patients undergoing supraglottoplasty are often routinely admitted post-operatively to the pediatric intensive care unit (PICU) due to rare but potentially fatal complications such as airway compromise. A systematic review was performed to determine the rate of post-operative PICU-level respiratory support required by pediatric patients following supraglottoplasty, to identify risk factors for patients who may benefit from post-operative PICU admission and limit unnecessary use of intensivist resources. REVIEW METHODS Key search terms 'supraglottoplasty' OR 'supraglottoplasties' were queried on three databases: CINHAL, Medline and Embase. Inclusion criteria were pediatric patients under 18 years of age who underwent a supraglottoplasty procedure with either an admission to PICU or requirement for PICU-level respiratory support. Risk of bias was assessed by two independent reviewers using QUADAS-2. Findings were critically appraised by three independent reviewers and pooled proportions of criteria meeting PICU admission were calculated for meta-analysis. RESULTS Nine studies met inclusion criteria, totaling 922 patients. Age at time of surgery ranged from 19 days to 15.7 years with mean age of 5.65 months. A weighted pooled estimate suggested that 19% (95% CI 14-24%) of patients who underwent supraglottoplasty required PICU-admission. The included studies revealed several patient and surgical factors have been linked to postoperative respiratory issues requiring PICU admission, including: neurological disease, perioperative oxygen saturation < 95%, prolonged surgical time and age < 2 months. CONCLUSIONS This study found that the majority of supraglottoplasty patients do not require significant postoperative respiratory support and suggests that routine PICU admission of these patients may be avoided by careful patient selection. Given the wide heterogeneity of outcome measures, further studies are needed to determine the ideal PICU admission criteria following supraglottoplasty.
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Affiliation(s)
- Esther ShinHyun Kang
- Faculty of Medicine, McGill University, Montreal, Canada
- Department of Anesthesia, McGill University Health Centre, Montreal, Canada
| | - Sena Turkdogan
- Faculty of Medicine, McGill University, Montreal, Canada
- Department of Otolaryngology - Head and Neck Surgery, McGill University Health Centre, Montreal, Canada
| | - Jeffrey C Yeung
- Faculty of Medicine, McGill University, Montreal, Canada.
- Department of Otolaryngology - Head and Neck Surgery, McGill University Health Centre, Montreal, Canada.
- Department of Pediatric Surgery, Montreal Children's Hospital, 1001 Decarie Blvd, Montreal, QC, H4A 3J1, Canada.
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Chen J, Xu H, Li X. Von Mises stress peak (VMSP) and laryngomalacia severity score (LSS) are extremely useful in the selection of treatment for laryngomalacia. Eur Arch Otorhinolaryngol 2023; 280:3287-3293. [PMID: 36757513 DOI: 10.1007/s00405-023-07866-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 01/29/2023] [Indexed: 02/10/2023]
Abstract
OBJECTIVE To analyze the judgment efficiency of a computer stress model and severity score in severity evaluation and treatment plan selection of laryngomalacia patients. METHODS Twenty-two children (12 cases in the operation group and 10 cases in the follow-up group) with moderate to severe laryngomalacia were assessed by laryngomalacia severity score (LSS) which included visual analogue scale (VAS) and clinical score. A computer stress model of the laryngeal cavity was constructed for all children, with the von Mises stress peak (VMSP) of the model used as another quantitative evaluation method. The ROC curves of two quantitative evaluation methods, the LSS and the VMSP, were analyzed respectively, according to the clinical guideline which is regarded as the gold standard for judging whether surgery is needed. The diagnostic efficiency indexes such as sensitivity, specificity, and accuracy were calculated. The area under ROC curves (AUC) of the two methods were compared by a DeLong model. Spearman correlation analysis and Kappa test were used to test the correlation and consistency of the two quantitative evaluation methods. The independent sample t test was used to compare the difference of LSS and VMSP between operation group and follow-up group. RESULTS The sensitivity, specificity, and accuracy of LSS in judging whether laryngomalacia was operated or not were 83.33%, 80.00% and 81.82%, respectively, and the area under ROC curve (AUC) was 0.825 (p < 0.05). The sensitivity, specificity, and accuracy of the computer stress model for laryngomalacia were 58.33%, 90.00% and 72.73%, respectively, and the AUC was 0.796 (p < 0.05). The spearman correlation coefficient between LSS and VMSP was 0.833, p < 0.001, which is statistically significant. LSS (t = 3.251, p = 0.004) and VMSP (t = 2.435, p = 0.024) of the two groups were statistically different. CONCLUSION VMSP and LSS have high diagnostic efficacy in the quantitative evaluation of the severity of laryngomalacia and the selection of treatment plan. The consistency of the two quantitative evaluation methods is good, which has practical value for the evaluation of the severity of laryngomalacia and has guiding significance for surgery.
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Affiliation(s)
- Jiali Chen
- Department of Otorhinolaryngology Head and Neck Surgery, Children's Hospital of Shanghai, Shanghai Jiao Tong University, 355th Luding Road, Shanghai, 200062, People's Republic of China
| | - Hongming Xu
- Department of Otorhinolaryngology Head and Neck Surgery, Children's Hospital of Shanghai, Shanghai Jiao Tong University, 355th Luding Road, Shanghai, 200062, People's Republic of China
| | - Xiaoyan Li
- Department of Otorhinolaryngology Head and Neck Surgery, Children's Hospital of Shanghai, Shanghai Jiao Tong University, 355th Luding Road, Shanghai, 200062, People's Republic of China.
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El-Sobki A, Ibrahim RAE, Amer A, Hashish MI, El-Deeb ME, El-Kholy NA, Abdelmeguid AS. Coblation supraglottoplasty: a ten-year experience in a tertiary referral hospital. Eur Arch Otorhinolaryngol 2021; 279:865-874. [PMID: 34654950 DOI: 10.1007/s00405-021-07130-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 10/06/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE The present study aims to review the outcomes of coblation supraglottoplasty performed for children with different types of laryngomalacia, and we discuss the factors affecting these outcomes. METHODS We retrospectively reviewed the medical records of laryngomalacia patients admitted to the Otorhinolaryngology Department, Mansoura University, from 2010 to 2020. We examined the patient's demography, symptoms, comorbidities, type of laryngomalacia, oxygen saturation, and final outcomes. RESULTS Our study included 235 patients; 122 patients responded to medical therapy, while 113 underwent surgical management. There is a significant relation between the types and therapy they underwent (p ≤ 0.001). Larger percentage within type I underwent medical therapy. There is a statistically significant difference between the studied groups regarding age at surgery. On pairwise comparison, patients with type II had the lowest age significantly at the surgery when compared with each other individual group (p ≤ 0.001). On multivariate regression analysis, the presence of comorbid congenital heart disease, neurological comorbidities significantly increased the risk of failure of surgical intervention by 17.32 and 5.803 folds, respectively. CONCLUSIONS Coblation supraglottoplasty is effective and safe to treat severe laryngomalacia. Different morphological types of laryngomalacia require slight surgical variations of coblation supraglottoplasty. The presence of comorbid congenital heart disease, neurological comorbidities significantly increased the risk of failure of surgical intervention.
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Affiliation(s)
- Ahmed El-Sobki
- Otorhinolaryngology Department, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Reham A E Ibrahim
- Phoniatrics Unit, Otorhinolaryngology Department, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Ayman Amer
- Phoniatrics Unit, Otorhinolaryngology Department, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | | | - Mohamed E El-Deeb
- Otorhinolaryngology Department, Faculty of Medicine, Kafrelsheikh University, El-giesh Street, Kafrelsheikh, Egypt.
| | - Noha Ahmed El-Kholy
- Otorhinolaryngology Department, Faculty of Medicine, Mansoura University, Mansoura, Egypt
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Xu H, Chen J, Pu S, Li X. Three-dimensional finite element modeling for evaluation of laryngomalacia severity in infants and children. J Int Med Res 2021; 48:300060520926407. [PMID: 32493145 PMCID: PMC7273773 DOI: 10.1177/0300060520926407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
This study was performed to investigate the feasibility of using a three-dimensional (3D) finite element model for laryngomalacia severity assessment. We analyzed laryngeal computed tomography images of seven children with laryngomalacia using Mimics software. The gray threshold of different tissues was distinguishable, and a 3D visualization model and finite element model were constructed. The laryngeal structure parameters were defined. The peak von Mises stress (PVMS) value was obtained through laryngeal mechanical analysis. The PVMS values of the laryngeal soft tissue and cartilage scaffolds were independently correlated with disease severity. After stress loading the model, the relationship between laryngomalacia severity and the PVMS value was apparent. However, the PVMS value of laryngeal soft tissue was not correlated with laryngomalacia severity. This study established the efficacy of a finite element model to illustrate the morphological features of the laryngeal cavity in infants with laryngomalacia. However, further study is required before widespread application of 3D finite element modeling of laryngomalacia. PVMS values of the laryngeal cartilage scaffold might be useful for assessment of laryngomalacia severity. These findings support the notion that structural abnormalities of the laryngeal cartilage may manifest as quantifiable changes in stress variants of the supraglottic larynx.
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Affiliation(s)
- Hongming Xu
- Department of Otolaryngology- Head and Neck Surgery, Children's Hospital of Shanghai, Shanghai Jiao Tong University, Shanghai, People's Republic of China
| | - Jiali Chen
- Department of Otolaryngology- Head and Neck Surgery, Children's Hospital of Shanghai, Shanghai Jiao Tong University, Shanghai, People's Republic of China
| | - Shilei Pu
- Department of Otolaryngology- Head and Neck Surgery, Children's Hospital of Shanghai, Shanghai Jiao Tong University, Shanghai, People's Republic of China
| | - Xiaoyan Li
- Department of Otolaryngology- Head and Neck Surgery, Children's Hospital of Shanghai, Shanghai Jiao Tong University, Shanghai, People's Republic of China
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Xu H, Chen F, Zheng Y, Li X. Efficacy and toxicities of low-temperature plasma radiofrequency ablation for the treatment of laryngomalacia in neonates and infants: a prospective randomized controlled trial. ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:1366. [PMID: 33313111 PMCID: PMC7723570 DOI: 10.21037/atm-20-3164] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
Abstract
Background Laryngomalacia is the most common cause of stridor in neonates and infants, and supraglottoplasty is the mainstay of surgical treatment. Although low-temperature plasma radiofrequency ablation (LTP-RFA) using coblation technology has been used for treating laryngomalacia, it is still lack of high-quality clinical evidence. Therefore, we conduct this prospective randomized study to clearly define the role of LTP-RFA for the treatment of laryngomalacia in neonates and infants. Methods Between Jan 2017 and Dec 2019, a total of 89 children with laryngomalacia were included for analysis. All patients were initially stratified according to the severity of laryngomalacia. Patients with severe laryngomalacia were randomly assigned to receive LTP-RFA or traditionally surgical supraglottoplasty, while patients with moderate laryngomalacia were assigned to LTP-RFA or observation. The primary end point was the efficacy and toxicities of LTP-RFA by assessing the changes of clinical score and visual analogue scale (VAS) symptom score. The total score was the combination of clinical score with VAS score. Results Of the 89 children, 40 children presented with severe laryngomalacia, and the remaining 49 children were diagnosed as moderate laryngomalacia. The median age was 68 days (range, 19 to 337 days). For children with severe laryngomalacia, our results showed that LTP-RFA treatment significantly reduced the operative time (5.55±1.66 vs. 18.7±5.31 min, P<0.001), length of hospital stay (6.71±1.15 vs. 7.95±1.55 days, P=0.008) and the amount of intraoperative hemorrhage (1.71±1.79 vs. 4.90±1.82, P<0.001) when compared to traditionally surgical supraglottoplasty, while the treatment efficacy was comparable between LTP-RFA and traditionally surgical supraglottoplasty in terms of changed total score (P=0.322), changed clinical score (P=0.135) and changed VAS symptom score (P=0.559). Additionally, for children with moderate laryngomalacia, LTP-RFA treatment significantly improved the symptom evaluated by total score (P<0.001), clinical score (P<0.001) and VAS symptom score (P<0.001) in comparison with the observation group. Post-operative pneumonia was observed in 10 patients. No surgical related death was reported. Conclusions The present study indicated that LTP-RFA was an effective treatment option for both severe and moderate laryngomalacia in neonates and infants with a low intraoperative complication. Long-term outcomes of LTP-RFA for laryngomalacia would be reported in further studies.
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Affiliation(s)
- Hongming Xu
- Department of Otolaryngology-Head and Neck Surgery, Children's Hospital of Shanghai, Shanghai Jiao Tong University, Shanghai, China
| | - Fang Chen
- Department of Otolaryngology-Head and Neck Surgery, Children's Hospital of Shanghai, Shanghai Jiao Tong University, Shanghai, China
| | - Yangyang Zheng
- Department of Otolaryngology-Head and Neck Surgery, Children's Hospital of Shanghai, Shanghai Jiao Tong University, Shanghai, China
| | - Xiaoyan Li
- Department of Otolaryngology-Head and Neck Surgery, Children's Hospital of Shanghai, Shanghai Jiao Tong University, Shanghai, China
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Sivarajah S, Isaac A, Anderson S, Mehta D, Hong P, Alrajhi Y, El-Hakim H. Validity of laryngomalacia classification systems: A multi-institutional agreement study. Clin Otolaryngol 2020; 45:471-476. [PMID: 32198979 DOI: 10.1111/coa.13530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Revised: 02/18/2020] [Accepted: 03/08/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To determine the agreement of paediatric otolaryngologists on classifying laryngomalacia (LM). DESIGN Intra- and interobserver agreement study of two classification systems. SETTING Three tertiary referral paediatric centres. PARTICIPANTS Three paediatric otolaryngologists, who were blinded to any clinical details, interpreted the videos of children diagnosed with LM using the Holinger and Olney classifications independently. They rated the videos twice with a washout period of at least 2 weeks. THE MAIN OUTCOME MEASURES Inter- and intra-observer agreement measured by overall Fleiss kappa and unweighted Cohen's kappa coefficients. The secondary outcome measures were inter- and intra-observer agreement on the individual anatomical subunits of the supraglottis affected by LM, characterised by the subcategories of the classifications. RESULTS Video records of infants and children <18 years who had an endoscopic diagnosis of LM from 2012 to 2017 were retrospectively chosen for inclusion (n = 73). The overall Fleiss kappa coefficient was 0.25 (95% CI 0.18-0.32) amongst the raters using the Holinger classification and 0.31 (95% CI 0.21-0.42) for the Olney classification. Intra-observer agreement using the Holinger classification was 0.30 (95% CI 0.18-0.42), 0.62 (95% CI 0.23-0.85) and 0.84 (95% CI 0.75-0.94], whilst the Olney classification yielded values of 0.41 (95% CI 0.26-0.56), 0.51 (95% CI 0.29-0.63) and 0.63 (95% CI 0.48-0.78). CONCLUSIONS The agreement on types of LM between expert observers is modest using the Holinger and Olney classifications. This has significant implications for accurately diagnosing LM and exposes potential obstacles against credible pooling of data and extrapolation of information.
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Affiliation(s)
- Shanmugappiriya Sivarajah
- Division of Otolaryngology Head & Neck Surgery, Division of Pediatric Surgery, Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
| | - Andre Isaac
- Division of Otolaryngology Head & Neck Surgery, Division of Pediatric Surgery, Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
| | - Shelaina Anderson
- Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Deepak Mehta
- Bobby R. Alford Department of Otolaryngology Head and Neck Surgery, Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA
| | - Paul Hong
- Pediatric Otolaryngology, Division of Otolaryngology-Head & Neck Surgery, Department of Surgery, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Yaser Alrajhi
- Division of Otolaryngology Head & Neck Surgery, Division of Pediatric Surgery, Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
| | - Hamdy El-Hakim
- Division of Otolaryngology Head & Neck Surgery, Division of Pediatric Surgery, Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
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Coagulation of the lateral surface of aryepiglottic folds as an alternative to aryepiglottic fold release in management of type 2 laryngomalacia. Auris Nasus Larynx 2019; 47:443-449. [PMID: 31677853 DOI: 10.1016/j.anl.2019.10.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2019] [Revised: 10/08/2019] [Accepted: 10/15/2019] [Indexed: 11/20/2022]
Abstract
OBJECTIVE Endoscopic supraglottoplasty is the procedure of choice in treatment of laryngomalacia with CO2 laser and cold steel being the most common instruments used with excellent results. However, bleeding, supraglottic stenosis and aspiration may occur leading to serious complications. Using coblation in management of laryngomalacia was found to be beneficial. Therefore, we conducted this study to evaluate the outcome of supraglottoplasty done by coagulation using coblation of the lateral surface of aryepiglottic folds as an alternative technique to aryepiglottic fold release in management of type 2 laryngomalacia. METHODS Retrospective study was conducted at Mansoura University Hospitals; Egypt from November 2017 to March 2018 included patients diagnosed with severe type 2 laryngomalacia. Supraglottoplasty was done by using coblator applied to the lateral surface of aryepiglottic folds allowing for lateral scarring thus widening the airway, preventing supraglottic collapse and avoiding re-stenosis. Outcome measures included assessment of presence or absence of the following symptoms preoperatively and postoperatively: inspiratory stridor, failure to thrive, choking and cyanosis. Preoperative and postoperative lowest oxygen saturation levels, weight-by-age percentile, and need for tracheostomy were assessed. RESULTS Nine patients were included in this study with a mean age of 3.78 ± 1.20 months (range 2-6 months). Overall success rate was 89%. The most significantly improved symptom was stridor (p-value 0.008). Significant improvement in lowest oxygen saturation levels (from 89.11 ± 3.06% pre-operatively to 96.44 ± 3.50% post-operatively) and weight gain (from 4288.9 ± 643.1 gm. preoperatively to 5505.55 ± 1017.4 gm. 1 month postoperatively) was achieved. No detected re-stenosis on follow up and none of our cases needed tracheostomy. CONCLUSION Supraglottoplasty by coagulation of the lateral surface of aryepiglottic folds using coblation is an effective and safe technique and can improve airway symptoms and weight gain in patients with type 2 laryngomalacia.
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