Acquired Idiopathic Laryngomalacia Treated by Laser Supraglottic Laryngoplasty

Abstract

Laryngomalacia is the most common cause of stridor in neonates and infants, where the soft cartilages and tissues surrounding the upper larynx collapse inward during respiration. On the other hand, acquired idiopathic laryngomalacia in adults is quite rare, but should be borne in mind for differential diagnosis of upper airway distress. Allergic factors may cause airway distress, but have not been highlighted previously as the background of laryngomalacia. In this report, we describe two patients with acquired idiopathic laryngomalacia with reference to allergic rhinitis and high serum levels of immunoglobulin E. The first patient was a 16-year-old female who presented with inspiratory stridor and dyspnea due to attachment between the epiglottis and bilateral arytenoids, and the second patient was an 18-year-old male who also presented with inspiratory stridor due to attachment between the epiglottis and posterior pharyngeal wall. The respiratory function of both patients was within the normal range but the inspiratory stridor interfered with daily life. Laryngomicrosurgery was performed in both patients using a CO 2 laser to remove the arytenoid mucosa in the first patient, and to remove the tip of the epiglottis in the second. Both patients were followed up while receiving oral anti-allergic agents. Laser supraglottic laryngoplasty to remove the vibrating excess tissue was effective for resolving the symptoms. However, recurrence occurred three times in the first patient, and inferior turbinotomy to improve nasal respiration was useful for diminishing the symptoms.

Supraglottoplasty for laryngomalacia with obstructive sleep apnea: A systematic review and meta‐analysis

“…Forty‐four studies were excluded for the following reasons: the number of patients undergoing polysomnography pre‐ and postsupraglottoplasty was not provided; no quantitative data for polysomnograms was provided; only adults were included; procedure(s) were performed in addition to the supraglottoplasty with no stratification of data for those who underwent isolated supraglottplasty; only preoperative data was available; some children were sedated with choral hydrate; the postoperative data was only available for a fraction of patients; portable pulse‐oximetry was used instead of formal polysomnography; or they were review articles …”

“…Forty-four studies were excluded for the following reasons: the number of patients undergoing polysomnography pre-and postsupraglottoplasty was not provided 43 ; no quantitative data for polysomnograms was provided 12,18,21,22,[24][25][26]28,29,[32][33][34][35][36][37][38][39]41,42,[44][45][46]49,51,53,54,56,58,61,64,66 ; only adults were included 19 ; procedure(s) were performed in addition to the supraglottoplasty with no stratification of data for those who underwent isolated supraglottplasty 27,50,63 ; only preoperative data was available 55 ; some children were sedated with choral hydrate 47 ; the postoperative data was only available for a fraction of patients 30 ; portable pulse-oximetry was used instead of formal polysomnography 31 ; or they were review articles. 40,52,62 Overall, there were a total of 138 patients (ages 1 month-12.6 years) with quantitative polysomnographic data who underwent isolated supraglottoplasty.…”

“…The searches yielded 517 studies, which were screened; 54 studies were reviewed in the full‐text version; and after reviewing the references, another three studies were potentially relevant and were also reviewed (57 total) . Thirteen studies met criteria for inclusion.…”

Adult Laryngomalacia: A Scoping Review

“…27,46 There were 17 patients from 13 studies with an idiopathic etiology, or one that was not necessarily specified. 11,20,21,[28][29][30][31][32]34,40,43,45,48 Seven studies specifically described the patient's symptoms as adult or acquired laryngomalacia. 11,21,28,30,32,43,48 Four studies reference reports of ALM in their descriptions.…”

“…11,20,21,[28][29][30][31][32]34,40,43,45,48 Seven studies specifically described the patient's symptoms as adult or acquired laryngomalacia. 11,21,28,30,32,43,48 Four studies reference reports of ALM in their descriptions. 20,29,31,40 One study mentions congenital laryngomalacia, but does not specifically mention ALM, 34 and 1 study mentions "laryngomalacia" but does not specify between congenital versus aquired.…”