[Successful treatment of laryngomalacia and bilateral vocal cord paralysis with continuous positive airway pressure].
BACKGROUND
Laryngomalacia is the most frequent congenital anomaly of airways, and it may cause obstructive sleep apneas. The associated vocal cord paralysis may aggravate the symptoms of upper airway obstruction.


METHODS
In a 14 month old boy severe laryngomalacia and bilateral vocal cord paralysis were diagnosed by flexible bronchoscopy. A sleep study showed a severe obstructive sleep apnoea (OSA). The patient was ventilated at home via the face mask with non invasive mechanical ventilation (CPAP) for a year. The level of pressure had to be set at 7 cm H2O to correct desaturation with an improvement in mean SpO2. On the follow up bronchoscopic examination laryngomalatia was improved, vocal cord paralysis persisted and sleep study revealed significant improvement.


CONCLUSIONS
In the patient with severe laryngomalatia and bilateral vocal cord paralysis with OSA conservative treatment with CPAP was used instead of a surgical intervention. Non invasive ventilation was used every night, for at least 6 hours, without adverse events. Invasive measurement of transdiaphragmatic pressure is the best way of titrating of CPAP level. This case report suggests the efficacy of noninvasive titrating of CPAP level by the hemoglobin oxygen saturation trend measurement.


CONCLUSIONS
In case of severe laryngomalatia and associated vocal cord paralysis, followed by OSA non invasive ventilation by nasal CPAP represents an effective and safe alternative to surgery.
Institut za zdravstvenu zastitu majke i deteta Srbije, Dr. Vukan Cupi, Beograd.
Aleksandar
A
Sovtić
Predrag
P
Minić
Miodrag
M
Vukcević
Milan
M
Rodić
D045422:Continuous Positive Airway Pressure; D006801:Humans; D007223:Infant; D055092:Laryngomalacia / Q000150:complications / Q000628:therapy*; D008297:Male; D020181:Sleep Apnea, Obstructive / Q000209:etiology / Q000628:therapy; D014826:Vocal Cord Paralysis / Q000150:complications / Q000628:therapy*