Laryngomalacia Commonly Presents With Snoring or Swallowing Dysfunction

By Will Boggs MD

May 15, 2014

NEW YORK (Reuters Health) - Laryngomalacia in children commonly presents with snoring and/or sleep-disordered breathing or with swallowing dysfunction, otolaryngologists from Canada report.

"Generally speaking I would discourage primary care physicians from establishing the diagnosis of laryngomalacia when they see a child with breathing or swallowing problems," said senior author Dr. Hamdy El-Hakim from The University of Alberta Hospitals in Edmonton, Alberta.

"Although it is true that laryngomalacia is a common diagnosis, attention should be diverted to prompt referral to a specialist with expertise in endoscopy to assess children with persistent stridor, snoring or swallowing problems," he told Reuters Health by email.

Most large series that reported presenting features of laryngomalacia have focused on classic laryngomalacia (usually presenting with stridor in early infancy) and have excluded older children and atypical presentations.

Dr. El-Hakim and colleagues used a retrospective medical chart review to identify the primary presentation of 88 children (mean age, 14.5 months; range, 0.2-96.0 months) diagnosed as having laryngomalacia.

The primary presenting complaint was stridor in 56 children, snoring and/or sleep-disordered breathing (S-SDB) in 22 children, and swallowing dysfunction in 10 children, according to the report, online May 8 in JAMA Otolaryngology - Head & Neck Surgery.

Fifty-nine children reported two or more categories of complaints, and 24 had complaints pertaining to all three presentations.

Twenty-five children had abnormal findings on sleep studies. On swallowing assessment, 21 children had aspiration, and eight had penetration.

Children presenting with S-SDB were generally older (mean age, 46.0 months), while children presenting with stridor were generally younger (mean age, 3.5 months). Children with swallowing dysfunction averaged 4.8 months of age at presentation.

Just over half of the children with stridor (55%), 27% of those with S-SDB, and 40% of those with swallowing dysfunction required surgical management with supraglottoplasty.

"We have a lot more to learn," Dr. El-Hakim said. "As we take interest and learn how to assess the impact of an airway problem on feeding and snoring, not just on stridor, and realize how the technology has changed with respect to fiberoptic scopes and anesthesia drugs, our understanding of the epidemiology will totally change."

"Knowledge from prior literature needs to change, and needs to be developed," Dr. El-Hakim concluded. "The threshold for helping a child with a breathing problem does not need to remain salvaging their life; rather it should be improvement of quality of life."

Dr. Paul Digoy from University of Oklahoma Health Sciences Center in Oklahoma City has published research on sleep apnea in infants with laryngomalacia, but was not involved in the new study.

"The problem is that there are two types of laryngomalacia and they tend to present at different times," he told Reuters Health by email. "The first is the common type seen mostly in infants (presenting at around 1-3 months of age). This can present with sleep apnea but mostly presents as stridor with agitation and may include retractions, dysphagia, and failure to thrive. The second tends to present later in life and may be underdiagnosed infant laryngomalacia that did not resolve. It presents with sleep-disordered breathing -- including snoring, stridor during sleep, restlessness, sleep apnea, and all the usual neurocognitive side effects."

"The bottom line is that children with laryngomalacia present in different ways and some present with sleep apnea symptoms only," Dr. Digoy said. "Those with sleep apnea symptoms alone tend to be older, and we do not have data on when/if this resolves with observation alone."

SOURCE: http://bit.ly/1mp7Gaq

JAMA Otolaryngol Head Neck Surg 2014.

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