title: Success of supraglottoplasty for severe laryngomalacia: the experience from Northeastern Ontario, Canada.
abstract: OBJECTIVE
  To review the outcomes of supraglottoplasty performed in children with severe laryngomalacia at a pediatric university teaching hospital and to determine if these outcomes are influenced by gender, age at time of supraglottoplasty, or medical comorbidities.
  
  
  METHODS
  Retrospective chart review of children who underwent supraglottoplasty for severe laryngomalacia between 2001 and 2010 at the Children's Hospital of Eastern Ontario in Ottawa, Canada. Statistical significance was obtained using 2-tailed Fisher's exact test. The outcome measures were resolution of laryngomalacia symptoms or persistence of laryngomalacia symptoms with or without additional surgery.
  
  
  RESULTS
  Among 26 post-primary supraglottoplasty patients, 46.2% had resolution and 53.8% had persistence, including 19.2% with partial improvement and 34.6% requiring revision supraglottoplasty and/or tracheostomy. Resolution was present in 35.7% of males and 58.3% of females (p = 0.43); in 33.3% of all patients ≤2 months old and 52.9% of all patients >2 months old (p = 0.43); and in 50.0% of non-comorbid patients ≤2 months old and 80.0% of non-comorbid patients >2 months old (p = 0.52). 71.4% of persistence cases were found in comorbid patients. 83.3% of comorbid patients had persistence, compared to 28.6% of non-comorbid patients (p=0.008). Of the 3 patients with overlapping comorbid categories, 2 required at least 2 revision supraglottoplasties and ultimately required a tracheostomy.
  
  
  CONCLUSIONS
  Persistence of laryngomalacia symptoms post-primary supraglottoplasty was not associated with gender or age at time of surgery, and was more commonly found in children with comorbidities. Patients with coexisting medical conditions appear to require more aggressive surgical management, beyond one revision supraglottoplasty.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, University of Ottawa, The Ottawa Hospital - General Campus, 501 Smyth Road, S3, Box 216, Ottawa, ON K1H 8L6, Canada. hwang.e@outlook.com
authors.forename: Euna
authors.initials: E
authors.lastname: Hwang
authors.forename: Jeffson
authors.initials: J
authors.lastname: Chung
authors.forename: Johnna
authors.initials: J
authors.lastname: MacCormick
authors.forename: Matthew
authors.initials: M
authors.lastname: Bromwich
authors.forename: Jean-Philippe
authors.initials: JP
authors.lastname: Vaccani
mesh_terms: D002170:Canada; D002675:Child, Preschool; D015897:Comorbidity; D005260:Female; D005931:Glottis / Q000601:surgery*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D055092:Laryngomalacia / Q000601:surgery*; D008297:Male; D009864:Ontario; D019651:Plastic Surgery Procedures / Q000379:methods*; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome