Sleep disordered breathing may signal laryngomalacia

Christine M. Clark, Dale S. DiSalvo, Jansie Prozesky, Michele M. Carr

Research output: Contribution to journalReview article

Abstract

Background: Pediatric anesthesiologists are often confronted with children with sleep-disordered breathing (SDB) presenting for tonsillectomy and/or anesthesia. The typical patient has symptoms of obstructive sleep apnea (OSA) with enlarged tonsils; however, a subset of patients may have underlying laryngomalacia (LM) without tonsillar hypertrophy. Both OSA and LM significantly increase the risk of intra- and postoperative airway obstruction and sensitivity to narcotics. The prevalence of LM may be underestimated, because direct laryngoscopy (DL) is not routinely performed in the diagnostic evaluation of patients with SDB who lack tonsillar hypertrophy. Aim: To identify the prevalence and DL findings in pediatric patients with SDB without tonsillar hypertrophy. Methods: Retrospective chart review of 108 patients with SDB who underwent general anesthesia for adenotonsillectomy (TA) or adenoidectomy with concomitant DL. The following data were collected: demographic information, medical comorbidities, polysomnography results, anesthetic techniques, and postoperative complications. Results: 94.5% of children had DL findings consistent with LM, including a retropositioned epiglottis and short aryepiglottic folds. Postglottic edema was observed in 42.2%, and these patients were significantly more likely to have a diagnosis of gastroesophageal reflux (P=0.023). 57.8% had vocal cord edema. 75.3% of children who received routine postoperative follow-up care experienced complete symptom resolution. Postoperative complications following discharge from hospital occurred in 12.4% of patients, and 15.7% underwent supraglottoplasty for continued SDB symptoms after TA or adenoidectomy. Conclusion: A substantial proportion of patients with SDB who lacked tonsillar hypertrophy had findings consistent with LM, suggesting that the larynx may be the primary site of upper airway obstruction in these patients. This has significant implications in terms of perioperative management. The majority of patients with SDB had symptomatic improvement following TA or adenoidectomy; however, a subset required further surgical intervention with supraglottoplasty.

Original languageEnglish (US)
Pages (from-to)68-74
Number of pages7
JournalOpen Anesthesiology Journal
Volume11
DOIs
StatePublished - Aug 1 2017

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Laryngomalacia
Sleep Apnea Syndromes
Laryngoscopy
Adenoidectomy
Hypertrophy
Obstructive Sleep Apnea
Airway Obstruction
Edema
Pediatrics
Epiglottis
Aftercare
Tonsillectomy
Polysomnography
Vocal Cords
Palatine Tonsil
Narcotics
Larynx
Gastroesophageal Reflux
General Anesthesia
Anesthetics

All Science Journal Classification (ASJC) codes

  • Anesthesiology and Pain Medicine

Cite this

Clark, Christine M. ; DiSalvo, Dale S. ; Prozesky, Jansie ; Carr, Michele M. / Sleep disordered breathing may signal laryngomalacia. In: Open Anesthesiology Journal. 2017 ; Vol. 11. pp. 68-74.
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title = "Sleep disordered breathing may signal laryngomalacia",
abstract = "Background: Pediatric anesthesiologists are often confronted with children with sleep-disordered breathing (SDB) presenting for tonsillectomy and/or anesthesia. The typical patient has symptoms of obstructive sleep apnea (OSA) with enlarged tonsils; however, a subset of patients may have underlying laryngomalacia (LM) without tonsillar hypertrophy. Both OSA and LM significantly increase the risk of intra- and postoperative airway obstruction and sensitivity to narcotics. The prevalence of LM may be underestimated, because direct laryngoscopy (DL) is not routinely performed in the diagnostic evaluation of patients with SDB who lack tonsillar hypertrophy. Aim: To identify the prevalence and DL findings in pediatric patients with SDB without tonsillar hypertrophy. Methods: Retrospective chart review of 108 patients with SDB who underwent general anesthesia for adenotonsillectomy (TA) or adenoidectomy with concomitant DL. The following data were collected: demographic information, medical comorbidities, polysomnography results, anesthetic techniques, and postoperative complications. Results: 94.5{\%} of children had DL findings consistent with LM, including a retropositioned epiglottis and short aryepiglottic folds. Postglottic edema was observed in 42.2{\%}, and these patients were significantly more likely to have a diagnosis of gastroesophageal reflux (P=0.023). 57.8{\%} had vocal cord edema. 75.3{\%} of children who received routine postoperative follow-up care experienced complete symptom resolution. Postoperative complications following discharge from hospital occurred in 12.4{\%} of patients, and 15.7{\%} underwent supraglottoplasty for continued SDB symptoms after TA or adenoidectomy. Conclusion: A substantial proportion of patients with SDB who lacked tonsillar hypertrophy had findings consistent with LM, suggesting that the larynx may be the primary site of upper airway obstruction in these patients. This has significant implications in terms of perioperative management. The majority of patients with SDB had symptomatic improvement following TA or adenoidectomy; however, a subset required further surgical intervention with supraglottoplasty.",
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Sleep disordered breathing may signal laryngomalacia. / Clark, Christine M.; DiSalvo, Dale S.; Prozesky, Jansie; Carr, Michele M.

In: Open Anesthesiology Journal, Vol. 11, 01.08.2017, p. 68-74.

Research output: Contribution to journalReview article

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AU - Clark, Christine M.

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AU - Prozesky, Jansie

AU - Carr, Michele M.

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N2 - Background: Pediatric anesthesiologists are often confronted with children with sleep-disordered breathing (SDB) presenting for tonsillectomy and/or anesthesia. The typical patient has symptoms of obstructive sleep apnea (OSA) with enlarged tonsils; however, a subset of patients may have underlying laryngomalacia (LM) without tonsillar hypertrophy. Both OSA and LM significantly increase the risk of intra- and postoperative airway obstruction and sensitivity to narcotics. The prevalence of LM may be underestimated, because direct laryngoscopy (DL) is not routinely performed in the diagnostic evaluation of patients with SDB who lack tonsillar hypertrophy. Aim: To identify the prevalence and DL findings in pediatric patients with SDB without tonsillar hypertrophy. Methods: Retrospective chart review of 108 patients with SDB who underwent general anesthesia for adenotonsillectomy (TA) or adenoidectomy with concomitant DL. The following data were collected: demographic information, medical comorbidities, polysomnography results, anesthetic techniques, and postoperative complications. Results: 94.5% of children had DL findings consistent with LM, including a retropositioned epiglottis and short aryepiglottic folds. Postglottic edema was observed in 42.2%, and these patients were significantly more likely to have a diagnosis of gastroesophageal reflux (P=0.023). 57.8% had vocal cord edema. 75.3% of children who received routine postoperative follow-up care experienced complete symptom resolution. Postoperative complications following discharge from hospital occurred in 12.4% of patients, and 15.7% underwent supraglottoplasty for continued SDB symptoms after TA or adenoidectomy. Conclusion: A substantial proportion of patients with SDB who lacked tonsillar hypertrophy had findings consistent with LM, suggesting that the larynx may be the primary site of upper airway obstruction in these patients. This has significant implications in terms of perioperative management. The majority of patients with SDB had symptomatic improvement following TA or adenoidectomy; however, a subset required further surgical intervention with supraglottoplasty.

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