Laryngomalacia, the most common congenital laryngeal anomaly in infants, is characterized by floppy supraglottic structures that collapse during inspiration, leading to airway obstruction. While many infants exhibit mild symptoms that can be managed conservatively, others require supraglottoplasty to address severe airway compromise, support growth, and maintain respiratory function. Identifying which infants are likely to need surgery remains a key challenge for pediatric otolaryngologists.
Robert Brinton Fujiki, PhD, CCC-SLP, from Indiana University School of Medicine, and Michael D. Puricelli, MD, from the University of Wisconsin-Madison, conducted a retrospective cohort study using electronic medical records from a tertiary children’s hospital. The study included 144 infants diagnosed with laryngomalacia, categorized into those who did not require surgery (n=82) and those who underwent supraglottoplasty (n=62). Diagnosis was confirmed by pediatric otolaryngologists using distal chip fiberoptic laryngoscopy. Researchers collected data on demographics, medical history, symptom severity, comorbidities, feeding assessments, and previous respiratory illnesses.
The analysis revealed the following findings:
- Infants with severe laryngomalacia symptoms were nearly three times more likely to require supraglottoplasty (adjusted odds ratio [aOR] 2.8).
- Sleep-disordered breathing increased the likelihood of surgery 5.6-fold.
- Infants with uncoordinated suck-swallow-breathe patterns during feeding had a 2.5 times higher risk of needing surgical intervention.
- A history of respiratory illnesses, including pneumonia or respiratory syncytial virus infection, significantly increased the probability of surgery.
- Infants who underwent surgery typically exhibited earlier symptom onset compared with those managed conservatively.
According to the authors, these findings highlight the importance of early and careful assessment of infants with laryngomalacia. “By recognizing symptom severity, sleep-disordered breathing, feeding coordination issues, and past respiratory illnesses, clinicians can more accurately identify infants who would benefit from timely supraglottoplasty,” the researchers noted.
The study emphasizes that while mild to moderate laryngomalacia is often monitored before deciding on surgery, early identification of these key predictors can help tailor management strategies and potentially prevent complications such as poor weight gain, chronic hypoxia, or failure to thrive.
"The study provides strong evidence that symptom severity, history of respiratory illness, sleep-disordered breathing, and feeding coordination patterns are critical predictors for surgical intervention in infants with laryngomalacia. Incorporating these indicators into clinical evaluations can support personalized care plans, ensuring infants receive the appropriate level of intervention at the right time," the authors concluded.
Reference:
Fujiki, R. B., & Puricelli, M. D. (2025). Predicting Surgical Intervention in Infants with Laryngomalacia. International Journal of Pediatric Otorhinolaryngology, 112582. https://doi.org/10.1016/j.ijporl.2025.112582
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