title: Congenital laryngomalacia is related to exercise-induced laryngeal obstruction in adolescence.
abstract: OBJECTIVE
  Congenital laryngomalacia (CLM) is the major cause of stridor in infants. Most cases are expected to resolve before 2 years of age, but long-term respiratory prospects are poorly described. We aimed to investigate if CLM was associated with altered laryngeal structure or function in later life.
  
  
  METHODS
  Twenty of 23 (87%) infants hospitalised at Haukeland University Hospital during 1990-2000 for CLM without comorbidities and matched controls were assessed at mean age 13 years. Past and current respiratory morbidity was recorded in a questionnaire, and spirometry performed according to standard quality criteria. Laryngoscopy was performed at rest and continuously throughout a maximal treadmill exercise test (continuous laryngoscopy exercise test (CLE-test)), and scored and classified in a blinded fashion according to preset criteria.
  
  
  RESULTS
  In the CLM group, laryngeal anatomy supporting CLM in infancy was described at rest in nine (45%) adolescents. Eleven (55%) reported breathing difficulties in relation to exercise, of whom 7 had similarities to CLM at rest and 10 had supraglottic obstruction during CLE-test. Overall, 6/20 had symptoms during exercise and similarities to CLM at rest and obstruction during CLE-test. In the control group, one adolescent reported breathing difficulty during exercise and two had laryngeal obstruction during CLE-test. The two groups differed significantly from each other regarding laryngoscopy scores, obtained at rest and during exercise (p=0.001 or less).
  
  
  CONCLUSIONS
  CLM had left footprints that increased the risk of later exercise-induced symptoms and laryngeal obstruction. The findings underline the heterogeneity of childhood respiratory disease and the importance of considering early life factors.
authors.affiliation: Department of Otolaryngology & Head and Neck Surgery, Haukeland University Hospital, Bergen, Norway.
authors.forename: Magnus
authors.initials: M
authors.lastname: Hilland
authors.affiliation: Department of Otolaryngology & Head and Neck Surgery, Haukeland University Hospital, Bergen, Norway Department of Pediatrics, Haukeland University Hospital, Bergen, Norway.
authors.forename: Ola Drange
authors.initials: OD
authors.lastname: Røksund
authors.affiliation: Department of Otolaryngology & Head and Neck Surgery, Haukeland University Hospital, Bergen, Norway.
authors.forename: Lorentz
authors.initials: L
authors.lastname: Sandvik
authors.affiliation: Department of Pediatrics, Haukeland University Hospital, Bergen, Norway Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.
authors.forename: Øystein
authors.initials: Ø
authors.lastname: Haaland
authors.affiliation: Department of Otolaryngology & Head and Neck Surgery, Haukeland University Hospital, Bergen, Norway Department of Clinical Medicine, University of Bergen, Bergen, Norway.
authors.forename: Hans Jørgen
authors.initials: HJ
authors.lastname: Aarstad
authors.affiliation: Department of Pediatrics, Haukeland University Hospital, Bergen, Norway Department of Clinical Science, Section for Pediatrics, University Bergen, Bergen, Norway.
authors.forename: Thomas
authors.initials: T
authors.lastname: Halvorsen
authors.affiliation: Department of Otolaryngology & Head and Neck Surgery, Haukeland University Hospital, Bergen, Norway Department of Clinical Medicine, University of Bergen, Bergen, Norway.
authors.forename: John-Helge
authors.initials: JH
authors.lastname: Heimdal
mesh_terms: D000293:Adolescent; D000402:Airway Obstruction / Q000209:etiology*; D002648:Child; D005080:Exercise Test / Q000009:adverse effects*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D055092:Laryngomalacia / Q000151:congenital / Q000209:etiology*; D007828:Laryngoscopy; D007830:Larynx / Q000002:abnormalities*; D008297:Male; D013147:Spirometry; D011795:Surveys and Questionnaires; D055815:Young Adult
keywords: Congenital laryngomalacia; Exercise induced inspiratory symptoms; Follow-up study; Respiratory Disorders; Vocal cord dysfunction