(292) Laryngomalacia: A Suggested Management Algorithm Based on a Numerical Score

Introduction: Stepwise management of pediatric laryngomalacia is one of the top challenging topics continuously discussed and updated by pediatric airway surgeons worldwide. Development of a management protocol based on a numerical score not only can facilitate decision making, but also creates a universal language for future studies.

Methods: A retrospective study evaluating all pediatric laryngomalacia cases over a 5-year period was conducted at our tertiary care center. The numerical score has three parts; history, examination and investigation with total score ranging from 0-15, 0-13 and 0-10 for each one, respectively. Each of them is the summation of number of checkpoints, graded as 0, 1, 2 or 3 according to the ascending severity.
Items of history score consists of questions regarding inspiratory sounds, cyanotic episodes, interrupted sleep, baby growth, feeding problems, and respiratory infections. Examination score includes evaluation of growth charts, chest retractions, degree of supraglottic collapse, swallowing and development. Investigation score involves; echocardiography, overnight desaturations, synchronous lesions and reflux assessment.
The algorithmic approach starts by classifying the cases into mild, moderate and severe groups by history score. Then, moderate group cases are evaluated by examination and subsequently investigation scores. Those with low scores are managed conservatively while those with higher score are surgical candidates. Clinical data, flow throughout the algorithm and internal consistency were analysed.

Results: 112 patients were included in this study. Classification of the patients using the history score yields three groups; Mild, 39.3%, Moderate, 42.86% and Severe, 17.85%. All the “mild” category cases never needed surgery during the follow-up period, a minimum of one year. Internal consistency for the three scores were good and calculated as; 0.83, 0.86 and 0.93 respectively.

Conclusions: This newly proposed numerical score with the associated algorithm is an applicable and reliable way to deal with, classify and properly manage laryngomalacia cases.