Abstract
Objective: 1) Compare flexible laryngoscopy findings between infants presenting with mild, moderate, and severe laryngomalacia. 2) Examine and understand the predictive valve of the initial laryngoscopy exam in those infants whose disease increases in severity from initial presentation.
Method: The flexible laryngoscopy exams of 201 infants with laryngomalacia from 2 separate institutions were recorded. The laryngeal findings were graded by the senior examiners. The infants were stratified into mild, moderate, and severe groups based on clinical severity. Laryngeal findings were then compared between the 3 groups.
Results: The mild group had 15.0% incidence of tight omega epiglottis while there was 27.7% and 34.2% in moderate and severe groups, respectively (P > .05). A retroflexed epiglottis seen in 39.5% of severe group, but 2.5% and 9.6% of mild and moderate, respectively (P < .05). Good visualization of vocal cords was seen in 35% of mild but 7.2% and 0% of moderate and severe, respectively (P < .05). Ventricular effacement was seen in 20.0% of mild group but 85.5% of moderate group (P < .05). The 47 infants with increasing severity of disease had the following rates: tight epiglottis, 31.9%; retroflexed epiglottis, 12.6%; good cord visualization, 10.6%; and ventricular effacement, 63.8%.
Conclusion: The laryngoscopic findings differ with disease severity. The infants who increased in severity had characterics associated with a higher severity of disease at initial presentation. The flexible laryngoscopic exam may be helpful in predicting which infants need will have an increase in severity of their disease and warrant closer follow-up.
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