Late Onset Laryngomalacia in Neurologically Normal Children

Abstract

Objective: Laryngomalacia in neurologically normal children over the age of 2 is uncommon. The purpose of our study was to determine the mode of presentation and mechanisms of obstruction. We retrospectively reviewed our hospital database to identify late onset laryngomalacia (LOM) patients who had confirmed endoscopic diagnosis of laryngomalacia.

Method: We retrospectively reviewed our hospital database to identify patients who had confirmed endoscopic diagnosis of laryngomalacia. Patients symptoms, age at diagnosis, co-morbidities, medical and surgical intervention, and short-term outcome (symptoms within 3 months) were recorded. Patients were excluded if they were symptomatic before 2 years of age or there were congenital anomalies involving upper aerodigestive tract.

Results: We identified 5 cases after searching our patient database over the past 5 years (from May 2005 to Jun 2010). Two patients presented with poor exercise tolerance at the ages of 13 and 14 years, while 2 younger patients (3 and 4 years) presented with obstructive sleep apnea (OSA) not relieved with adenotonsillectomy. All patients responded well to the surgery combined with antireflux therapy.

Conclusion: LOM presents with a variety of symptoms rather than the typical inspiratory stridor well recognized of infantile laryngomalacia. Our patients more commonly present as OSA or exercise induced inspiratory stridor. The mechanisms of late presentation appear to be unclear.