Acid Reflux Medication Linked to Supraglottoplasty in Infants with Laryngomalacia: JAMA

The research, led by Dr. Habib Zalzal from the Department of Otolaryngology at Children’s National Hospital, Washington, DC, sought to determine whether gastroesophageal reflux disease (GERD) medications influence the need for surgical intervention in infants with nonsevere laryngomalacia—a condition characterized by noisy breathing due to soft, floppy tissue above the vocal cords.

The retrospective cohort study analyzed medical records from 395 infants under six months of age who were initially evaluated for nonsevere laryngomalacia at a pediatric otolaryngology airway clinic between 2014 and 2023. Participants were divided into two groups based on the initial management approach: those treated conservatively through observation (n=320) and those who received GERD medications (n=75).

The primary focus of the study was to compare how often infants in each group eventually required supraglottoplasty, a surgical procedure performed to relieve airway obstruction caused by laryngomalacia.

The key findings of the study were as follows:

• The overall rate of supraglottoplasty among all infants analyzed was 4.1%.
• In the observation-only group, 3.4% of infants underwent surgery.
• In the GERD medication group, 6.7% of infants required supraglottoplasty.
• This reflects a modest increase in surgery among infants treated with acid suppression therapy.
• The difference in surgery rates between the two groups was −3.2%, indicating limited statistical precision.
• Female sex and the severity of laryngomalacia based on endoscopic findings were stronger predictors of surgery than GERD medication use.

Despite its limitations, including the retrospective design and single-institution data, the study highlights an important clinical consideration: acid reflux medications, commonly prescribed for infants with laryngomalacia despite limited evidence of benefit, may not significantly reduce the need for surgery and could be associated with a slightly higher likelihood of surgical intervention.

Ultimately, the findings support a more cautious approach to prescribing GERD medications in this population, especially for those with mild symptoms who are otherwise stable. Clinicians are encouraged to weigh the potential risks and benefits of acid suppression therapy and continue relying on individualized assessment, including endoscopic findings, when deciding the best course of treatment.

The researchers concluded, "The study found that infants with nonsevere laryngomalacia had similar rates of supraglottoplasty whether they were treated with GERD medications or simply observed. Female infants and those with more severe laryngomalacia seen on endoscopy were more likely to need surgery after a period of watchful waiting."

Reference:

Zalzal H, Pershad A, Behzadpour H, Rana MS, Zalzal G. Association Between Acid Reflux Medication and Supraglottoplasty in Infant Laryngomalacia. JAMA Otolaryngol Head Neck Surg. Published online May 29, 2025. doi:10.1001/jamaoto.2025.1201