title: Utility of polysomnography in determination of laryngomalacia severity.
abstract: OBJECTIVE
  To examine the efficacy of polysomnography in determining the severity of laryngomalacia in pediatric patients.
  
  
  METHODS
  Prospective cohort study. Pediatric patients referred to our pediatric otolaryngology department with a polysomnogram already performed for a presumptive diagnosis of laryngomalacia were enrolled in the study. Patients with concurrent airway lesions or neuromuscular disorders were excluded. Patients underwent history, physical exam, and flexible fiberoptic laryngoscopy. These results were used to calculate a total laryngomalacia severity score.
  
  
  RESULTS
  25 pediatric patients (n = 25) with an average age of 3.9 months at time of initial evaluation met criteria for enrollment in our study. 100% of patients had obstructive sleep apnea by definition. 80% of these patients underwent supraglottoplasty. The average AHI of those who underwent surgery (57.26) was not significantly different in those who underwent surgery vs. those that did not (55.43) (p = 0.41). In comparison, the average laryngomalacia severity score based from history, physical exam and flexible laryngoscopy was significantly greater in the patients that required supraglottoplasty (11.16) vs. those who did not (5.33) (p = 0.03). In addition a higher laryngomalacia severity score was not correlated with a higher AHI (p = 0.81, r = 0.08, CI: -0.5197 to 0.6235).
  
  
  CONCLUSIONS
  In our cohort, polysomnography was not useful in determining the severity of laryngomalacia, did not correlate with the clinical evaluation, and alone was not predictive of the patients that would require surgical intervention. History, physical exam, and endoscopic findings remain reliable predictors of disease severity and need for operative intervention.
authors.affiliation: Tulane University School of Medicine, Department of Otolaryngology/Head and Neck Surgery, New Orleans, LA, USA.
authors.forename: Jacqueline E
authors.initials: JE
authors.lastname: Weinstein
authors.affiliation: Tulane University School of Medicine, Department of Otolaryngology/Head and Neck Surgery, New Orleans, LA, USA. Electronic address: clawlor@tulane.edu.
authors.forename: Claire M
authors.initials: CM
authors.lastname: Lawlor
authors.affiliation: Tulane University School of Medicine, Department of Otolaryngology/Head and Neck Surgery, New Orleans, LA, USA.
authors.forename: Eric L
authors.initials: EL
authors.lastname: Wu
authors.affiliation: Tulane University School of Medicine, Department of Otolaryngology/Head and Neck Surgery, New Orleans, LA, USA; Ochsner Clinic Foundation, Department of Pediatric Otolaryngology, New Orleans, LA, USA.
authors.forename: Kimsey H
authors.initials: KH
authors.lastname: Rodriguez
mesh_terms: D015331:Cohort Studies; D005260:Female; D006801:Humans; D007223:Infant; D055092:Laryngomalacia / Q000150:complications*; D007828:Laryngoscopy; D008297:Male; D008487:Medical History Taking; D010808:Physical Examination; D017286:Polysomnography; D012720:Severity of Illness Index; D020181:Sleep Apnea, Obstructive / Q000150:complications
keywords: Laryngomalacia; Obstructive sleep apnea; Polysomnogram