Late-onset laryngomalacia: a cause of pediatric obstructive sleep apnea.
OBJECTIVE
To describe the presentation, diagnosis, and treatment of late-onset laryngomalacia in children with obstructive sleep apnea syndrome (OSAS).


METHODS
Retrospective study.


METHODS
Tertiary care children's hospital.


METHODS
Seventy-seven children were identified who had OSAS diagnosed by polysomnography and underwent airway endoscopy to evaluate for laryngomalacia between July 2006 and December 2008. Children with significant neurologic disease or craniofacial malformations were excluded. Seven children under 3 years of age had laryngomalacia and OSAS (Group A), 19 children 3-18 years of age had laryngomalacia and OSAS (Group B), and 51 children 3-18 years of age had OSAS but not laryngomalacia (Group C).


METHODS
Comparison of pre-operative findings, intra-operative findings, interventions, and outcomes between the 3 groups.


RESULTS
Group A was consistent with previous reports of congenital laryngomalacia with respect to presentation, diagnosis, and treatment. Groups B and C had similar pre-operative findings, including a high incidence of adenotonsillar hypertrophy, and the only significant difference was the intra-operative finding of laryngomalacia in Group B. Treatments were individualized to include supraglottoplasty, adenoidectomy, tonsillectomy, adenotonsillectomy, or a combination of the above. Of the 52 patients who returned in follow-up, 44 noted improvement, but this was rarely confirmed by polysomnogram.


CONCLUSIONS
Late-onset laryngomalacia may act alone or in concert with additional dynamic or fixed lesions to cause pediatric OSAS. Although there is no specific pre-operative indicator to diagnose late-onset laryngomalacia, it can be readily identified intra-operatively and effectively treated with supraglottoplasty, with or without concurrent adenotonsillectomy.
The University of Texas Health Science Center at San Antonio, United States. revell@uthscsa.edu
Sally M
SM
Revell
William D
WD
Clark
D000233:Adenoidectomy / Q000009:adverse effects / Q000379:methods; D000293:Adolescent; D017668:Age of Onset; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006776:Hospitals, Pediatric; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D055092:Laryngomalacia / Q000175:diagnosis* / Q000453:epidemiology* / Q000601:surgery; D007828:Laryngoscopy / Q000379:methods; D008297:Male; D017286:Polysomnography / Q000379:methods; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D020181:Sleep Apnea, Obstructive / Q000175:diagnosis* / Q000453:epidemiology* / Q000628:therapy; D013997:Time Factors; D014068:Tonsillectomy / Q000009:adverse effects / Q000379:methods; D016896:Treatment Outcome