Comprehensive Management of Laryngomalacia and Its Variants

PROGRAM DESCRIPTION: Laryngomalacia, can cause significant disturbances in respiration and swallowing. The congenital form is well recognized, but its late variants are less understood. Variation in disease severity and presentation require an in-depth understanding of risk factors and co-morbidities. This session will offer a comprehensive perspective on the etiology, pathophysiology and management of laryngomalacia and its concordant aerodigestive disorders. The course will include the role of acid suppression treatment along with controversies surrounding its use in children. In addition to congenital laryngomalacia, a methodical approach to neurologic, sleep, feeding, persistent, late onset, and exercise-induced variant laryngomalacia will be described. Medical and surgical approaches to all variants will be gained through case examples. Specific attention will be paid to the use of Drug Induce Sleep Endoscopy (DISE) in evaluation of laryngomalacia as part of the spectrum of pediatric OSA evaluation and management. Expected results, potential complications, and routine perioperative management will be addressed with specific attention to contemporary management, treatment controversies, and periop considerations. A stepwise approach to supraglottoplasty decisions and failure is presented including algorithm for further diagnostic testing for reflux and Central Nervous System disease. Specific surgical technique recommendations for revision surgery are presented. As stridor and feeding difficulty create significant anxiety for parents, we demonstrate how the incorporation of an aerodigestive holistic team approach that includes swallowing therapist , nurses, and providers reduces parental anxiety. Expanded indications for surgical intervention for infant and family quality of life are also presented.

OUTCOME OBJECTIVE 1: 1) Review the etiology of congenital laryngomalacia and predictors of disease severity and treatment outcomes while describing conventional and controversial medical and surgical approaches.

OUTCOME OBJECTIVE 2: Describe atypical laryngomalacia presentations and role in childhood OSA, feeding disorders and exercise intolerance. Interventions and outcomes addressed.

OUTCOME OBJECTIVE 3: Apply holistic approach to evaluation, management and surgical intervention for best outcomes and improved quality of life in children with laryngomalacia.

BACKGROUND STATEMENT: We provide a framework for the D&M of the most common cause for infant noisy breathing and contributor to other childhood conditions. Participates will learn when to perform SGP and predict outcomes. We discuss all contemporary controversies and provide video of surgery techniques.