Adult-onset laryngomalacia: case reports and review of management

Abstract

Laryngomalacia is a dynamic airway condition characterised by inward collapse of flaccid supraglottic structures during inspiration. Although the most common cause of stridor in the paediatric population, adult-onset laryngomalacia remains a rare entity and its management, challenging. Two cases of adult-onset laryngomalacia are reported. A review of the English literature is performed and additional publications identified by hand-searching relevant papers; 13 case reports/series comprising 28 cases of adult-onset laryngomalacia were identified, divided into two main groups: idiopathic (6/28) and acquired (22/28). The aetiology of the acquired form includes neurological, traumatic and iatrogenic. Reported therapeutic measures used are laser supraglottoplasty, epiglottopexy, partial epiglottidectomy, defunctioning tracheostomy and intubation whilst correcting the underlying cause. The majority of patients only required one therapeutic procedure (follow-up of 2-24 months). A strong index of suspicion is required to diagnose adult-onset laryngomalacia aided by in-office laryngoscopy. The rarity of this condition prevents management-based randomised controlled trials.

Atypical Presentation of Severe Laryngomalacia Managed with Aryepiglottoplasty and A Novel Suture Technique

“…In view of the clinical picture of endoscopic finding of short aryepiglottic fold with long epiglottis and multiple failed attempts of extubation surgery was planned in the present case. Hey et al reported adult onset laryngomalacia in 2 patients [18] , Hyodo et al reported adult onset layngomalacia in a 20 year old female [19] and in this study we report the same in 12 year old male patient. Richter et al also reported a series of late onset laryngomalacia where 17 patients were diagnosed as having laryngomalacia when they were older than 2 years(mean age at onset 6.6 years) [20] .…”

Epiglottis collapse in adult obstructive sleep apnea: A systematic review

“…7,8 Laxity of the epiglottis is commonly discussed in the pediatric literature as one of the possible presentations of congenital laryngomalacia 9 ; however, the adult form is a rare entity that has not been well described. 10 The majority of reported cases are secondary to neurological injuries, head and neck surgery, or trauma. [11][12][13][14] Epiglottis collapse during sleep has been estimated to occur in around 12% of adult patients with OSA.…”

Dynamic Drug-Induced Sleep Computed Tomography in Adults With Obstructive Sleep Apnea

“…Positional therapy seems to offer good results 28 , and epiglottidectomy has been reported to provide the most effective solution to treat epiglottis collapse 29 . Further, the high occurrence rate of epiglottis collapse in patients with OSA can partially explain the residual AHI in these patients after multi-level surgery, which usually does not include procedures for the epiglottis 30 .…”