title: A systematic review of the evidence on spontaneous resolution of laryngomalacia and its symptoms.
abstract: OBJECTIVE
  Laryngomalacia (LM) is the most common cause of congenital stridor. Tradition holds that the majority of patients resolve spontaneously by 12-18 months of age. The objective of this study was to systematically review the literature on the spontaneous resolution of LM and/or its presenting symptoms, in otherwise healthy infants.
  
  
  METHODS
  Data sources included Medline/PubMed, EMBASE, Scopus, CINAHL, Proquest, Cochrane database, Cochrane Methodology Register, Web of Science Conference Proceedings Citation Index, and ACP Journal Club. Study inclusion criteria included participants with an endoscopic diagnosis of LM, and symptoms of stridor, swallowing dysfunction, and/or snoring/sleep-disordered breathing, that documented subjective or objective resolution endpoints. Surgical series, case reports, and narrative reviews were excluded. Studies with insufficient follow-up (<3 months), and patients with comorbidities without subgroup analysis were excluded. Two independent reviewers extracted follow-up duration, rate of retention, time to resolution of LM, and method of documentation of resolution.
  
  
  RESULTS
  Of the 1146 articles identified, three met inclusion/exclusion criteria (n=411 patients). All were retrospective and used stridor resolution as the only endpoint. Resolution rate was 89%, with time to resolution ranging from 4 to 42 months. Level of evidence was low, and studies suffered from lack of follow-up, and no objective endpoints. Meta-analysis was not possible.
  
  
  CONCLUSIONS
  Endoscopic evidence of the natural history of laryngomalacia and its resolution is lacking. Low level of evidence supports that stridor and respiratory distress resolve, but the range of the time to resolution and rate of resolution is wide. Other clinical manifestations have not been studied. Prospective longitudinal trials are required to better understand the natural history.
authors.affiliation: Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Alberta, Edmonton, AB, Canada. Electronic address: aisaac@ualberta.ca.
authors.forename: Andre
authors.initials: A
authors.lastname: Isaac
authors.affiliation: Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Alberta, Edmonton, AB, Canada.
authors.forename: Han
authors.initials: H
authors.lastname: Zhang
authors.affiliation: Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Alberta, Edmonton, AB, Canada; Division of Pediatric Surgery, Department of Pediatrics, The Stollery Children's Hospital, Edmonton, AB, Canada.
authors.forename: Sue Rene
authors.initials: SR
authors.lastname: Soon
authors.affiliation: Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada.
authors.forename: Sandra
authors.initials: S
authors.lastname: Campbell
authors.affiliation: Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Alberta, Edmonton, AB, Canada; Division of Pediatric Surgery, Department of Pediatrics, The Stollery Children's Hospital, Edmonton, AB, Canada.
authors.forename: Hamdy
authors.initials: H
authors.lastname: El-Hakim
mesh_terms: D015897:Comorbidity; D006801:Humans; D007223:Infant; D055092:Laryngomalacia / Q000175:diagnosis* / Q000503:physiopathology*; D008297:Male; D011379:Prognosis; D012135:Respiratory Sounds
keywords: Laryngomalacia; Outcomes; Pediatrics; Resolution; Stridor