title: Secondary airway lesions in laryngomalacia: a different perspective.
abstract: OBJECTIVE
  To document the prevalence of secondary airway lesions (SALs) among children with laryngomalacia (LM).
  
  
  METHODS
  A cross-sectional observational study.
  
  
  METHODS
  Single practice in a tertiary care pediatric facility.
  
  
  METHODS
  Patients diagnosed with LM were initially identified from a prospectively kept surgical database. Patients with cardiac/large-vessel malformations, prematurity, repeated or prolonged intubations, acute infections, or prior airway surgery were excluded. Only children who had a full examination of the airway were included. Other associated diagnoses along with demographics, surgical intervention, and type of LM were included.
  
  
  RESULTS
  Over an 8-year period, 1112 patients underwent laryngoscopy and bronchoscopy. A total of 108 consecutive cases were diagnosed with LM (78 primary diagnosis and 30 secondary diagnosis). After excluding 17 with disorders associated with large airway disease, 91 LM patients were included. The mean age was 553.23 days (ranging between 5 days and 15 years); 60 were boys and 31 were girls. The prevalence of SALs was 7.7% (95% confidence interval, 7.65-7.76; 7 children; 4 subglottic stenosis, 4 tracheomalacia, 1 bronchomalacia, and 1 choanal atresia). Fifty-nine patients underwent supraglottoplasties, while 1 patient had a tracheostomy.
  
  
  CONCLUSIONS
  After accounting for conditions known to be associated with large airway lesions, the prevalence of SALs associated with laryngomalacia was much less than previously reported. The authors hypothesize that the upper-end figures are a reflection of highly select cohorts and the inclusion of patients with other pathology known to be associated with subglottic stenosis, tracheomalacia, and bronchomalacia and low thresholds for diagnosing mild subglottic stenosis.
authors.affiliation: Pediatric Otolaryngology, Division of Pediatric Surgery, Department of Surgery, The Stollery Children's Hospital & University of Alberta Hospitals, Edmonton, Alberta, Canada.
authors.forename: Hani A
authors.initials: HA
authors.lastname: Rifai
authors.forename: Marc
authors.initials: M
authors.lastname: Benoit
authors.forename: Hamdy
authors.initials: H
authors.lastname: El-Hakim
mesh_terms: D000293:Adolescent; D000402:Airway Obstruction / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology*; D001999:Bronchoscopy; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D055092:Laryngomalacia / Q000150:complications / Q000175:diagnosis* / Q000453:epidemiology; D007828:Laryngoscopy; D007829:Laryngostenosis / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology*; D008297:Male; D008404:Massachusetts / Q000453:epidemiology; D012189:Retrospective Studies