Laryngomalacia

For most infants with laryngomalacia (LM) the prognosis is excellent. The natural course typically involves gradual worsening after onset, with subsequent spontaneous resolution. LM is most severe when the child is 6 to 8 months of age, before gradually improving spontaneously by 12 to 24 months of age.[22]Olney DR, Greinwald JH Jr, Smith RJ, et al. Laryngomalacia and its treatment. Laryngoscope. 1999 Nov;109(11):1770-5. http://www.ncbi.nlm.nih.gov/pubmed/10569405?tool=bestpractice.com Treatment methods aim to minimise the effects of LM while the underlying pathology undergoes its natural course of resolution.

In more significant disease, endoscopic supraglottoplasty addresses airway obstruction by widening the supraglottic airway. Outcomes are predominantly good, although partial improvement or failure is possible, with complications developing and symptoms persisting long-term. The relative risk of supraglottoplasty failure has been found to be significantly higher in patients with medical comorbidities.[44]Preciado D, Zalzal G. A systematic review of supraglottoplasty outcomes. Arch Otolaryngol Head Neck Surg. 2012 Aug;138(8):718-21. http://www.ncbi.nlm.nih.gov/pubmed/22801660?tool=bestpractice.com Repeated endoscopic procedures can be undertaken if required. Supraglottic stenosis may occur after supraglottoplasty, with long-term airway narrowing persisting after the LM has resolved.

Neurological-variant LM may temporarily improve after surgery but often gradually deteriorates once again. This variant may persist beyond 2 years of age. Tracheostomy provides definitive therapy but at the cost of substantial potential morbidity.