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Laryngology/Broncho-Esophagology

(018) Adult laryngomalacia: A systematic scoping review with meta-analysis

Monday, October 2, 2023
2:45 PM – 3:45 PM East Coast USA Time
Has Audio

    Presenting Author(s)

  • John F. Mills

    Medical Student
    Albany Medical College
    Summerville, South Carolina, United States

    • Co-Author(s)

  • Neil P. Monaghan, BS

    Clinical Research Fellow
    Medical University of South Carolina
    Charleston, South Carolina, United States

  • SN

    Shaun A. Nguyen, MD, FAPCR

    Professor- Director of Clinical Research
    Medical University of South Carolina
    Charleston, South Carolina, United States

  • AO

    Ashli K. O'Rourke, MD

    Professor
    Medical University of South Carolina
    Charleston, South Carolina, United States

  • LH

    Lucinda Halstead, MD

    Medical Director , Evelyn Trammell Institute for Voice & Swallowing
    Medical University of South Carolina
    Charleston, South Carolina, United States

    • Senior Author(s)

  • Ted A. Meyer, MD PhD

    Professor
    Medical University of South Carolina
    Charleston, South Carolina, USA

Disclosure(s):
Neil P. Monaghan, BS: No relevant relationships to disclose.
Shaun A. Nguyen, MD, FAPCR: No relevant relationships to disclose.
Ashli K. O'Rourke, MD: No relevant relationships to disclose.
Lucinda Halstead, MD: No relevant relationships to disclose.


Introduction: This review sought to determine the characteristics of adults diagnosed with new onset laryngomalacia including airway symptoms, laryngoscopic findings, treatments, and outcomes. Moreover, we wanted to highlight suspected limitations in the literature.

Methods: The search was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis extension for Scoping Reviews (PRISMA-ScR) checklist by two independent investigators. Studies were identified through CINAHL, Cochrane Review, PubMed, and Scopus for articles published from inception through May 2023. Our goal was to identify broad information on patient characteristics, as well as the suspected etiology including neurologic, traumatic, iatrogenic, and idiopathic causes. A meta-analysis of continuous measures and proportions was performed.

Results: Of the 1,121 abstracts identified, 33 articles pertaining to laryngomalacia in the adult population were included. The most common presenting symptoms were stridor at rest (78.3%, 65.1 to 88.3) and dyspnea with exertion (83.8%, 64.8 to 96.3). The most suspected etiology was exercise-induced (86.0%, 69.4 to 95.5), and the most common description of laryngomalacia on visualization was collapse of supraglottic structures during exercise (93.3%, 79.0 to 99.1). Non-surgical options were attempted in 87.0% (54.0 to 99.1), which included oral appliances, respiratory retraining, breathing techniques, and working with a speech pathologist. Surgical options were ultimately performed in 84.2% (75.0 to 91.0). Complete resolution of symptoms following therapy was seen in 61.9% (48.0 to 74.6).

Conclusions: Adult onset laryngomalacia is difficult to characterize. It typically presents in patients during exercise, with neurological injury, or idiopathically. Surgical management can lead to improvement or complete resolution of symptoms. The need for a universal nomenclature is highlighted in this review, as it is inconsistently classified.