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Contents
1.
Consensus objectives ....................................................................................................................................................................................................................................... 257
2.
Target population .............................................................................................................................................................................................................................................. 257
3.
Intended users ................................................................................................................................................................................................................................................... 257
4.
Methods ............................................................................................................................................................................................................................................................... 257
4.1.
Abbreviations ........................................................................................................................................................................................................................................ 257
5.
Recommendations and justification ........................................................................................................................................................................................................... 257
6.
Disclaimer ............................................................................................................................................................................................................................................................ 257
6.1.
Section 1:
evaluation and treatment considerations .............................................................................................................................................................. 257
6.2.
Section 2:
initial presentation algorithm .................................................................................................................................................................................... 257
6.3.
Section 3:
comprehensive care algorithm .................................................................................................................................................................................. 257
6.4.
Section 4:
management of the difficult to feed infant with laryngomalacia ................................................................................................................. 259
6.5.
Section 5:
post-surgical treatment algorithm and persistent laryngomalacia .............................................................................................................. 259
6.6.
Section 6:
recommendations for acid suppression therapy ................................................................................................................................................. 259
Conflict of interest ............................................................................................................................................................................................................................................ 261
Acknowledgements .......................................................................................................................................................................................................................................... 261
1. Consensus objectives
To provide recommendations for the comprehensive manage-
ment of young infants who present with signs or symptoms
concerning for laryngomalacia.
2. Target population
Pediatric patients with signs concerning for laryngomalacia.
3. Intended users
These consensus recommendations are intended to:
1. Provide initial care and triage recommendations for primary care
practitioners and other health care providers who commonly
evaluate young infants with noisy breathing.
2. Provide comprehensive care recommendations for otolaryngolo-
gists who manage young infants with laryngomalacia.
4. Methods
Expert opinion by the members of the International Pediatric Oto-
laryngology Group (IPOG). The mission of the IPOG is to develop
expertise-based consensus recommendations for the manage-
ment of pediatric otolaryngologic disorders with the goal of
improving patient care. The consensus recommendations herein rep-
resent the second publication by the group.
4.1. Abbreviations
AP, anterior and posterior; CXR, chest x-ray; FEES, fiberoptic en-
doscopic evaluation of swallowing; FFL, flexible fiberoptic
laryngoscopy; H2RA, histamine-2 blocker; IPOG, International Pe-
diatric Otolaryngology Group; MRI, magnetic resonance imaging;
PPI, proton pump inhibitor; VFSS, video fluoroscopic swallow
study.
5. Recommendations and justification
The recommendations are outlined in the following appendices
•
Section 1
:
evaluation and treatment considerations
•
Section 2
:
initial presentation algorithm
•
Section 3
:
comprehensive care algorithm
•
Section 4
:
management of the difficult to feed infant with
laryngomalacia
•
Section 5
:
post-surgical treatment algorithm
•
Section 6
:
recommendations for acid suppression therapy
6. Disclaimer
Members of the International Pediatric ORL Group (IPOG) pre-
pared this report. Consensus recommendations are based on the
collective opinion of the members of this group. Any person seeking
to apply or consult the report is expected to use independent medical
judgment in the context of individual patient and institutional
circumstances.
6.1.
Section 1
:
evaluation and treatment considerations
The members of the IPOG identified five frequently debated eval-
uation and treatment considerations in the management of
laryngomalacia. Variation in practice among the current group
members remains, and the purpose of this section is to provide a
list of reasonable options based on expert opinion (
Table 1
).
6.2.
Section 2
:
initial presentation algorithm
The initial presentation algorithm is designed to guide the
initial evaluation of the infant presenting with inspiratory stridor.
This may vary depending on what type of medical care setting the
infant presents in. Urgency of referral to an otolaryngologist is
guided by severity of disease. Those with more severe disease
may warrant expedited referral and those who have significant
apnea/desaturations and/or inability to feed may warrant inpa-
tient admission. Those infants who may be aspirating and/or
have pulmonary disease may benefit from chest x-ray to further
evaluate this. Flexible fiberoptic laryngoscopy (FFL) by an otolar-
yngologist is important to confirm the diagnosis. Those infants
whose laryngoscopy findings are not commensurate with the
severity of their symptoms may benefit from airway films to
screen for a secondary airway lesion. Further recommendations
are detailed in
Fig. 1
.
6.3.
Section 3
:
comprehensive care algorithm
The algorithm in
Fig. 2
was designed to guide treatment for the
infant that has been diagnosed with laryngomalacia, confirmed by
FFL. This algorithm stratifies management decisions based on disease
severity. The group suggests that the provider should recognize the
presence of co-morbidities (see
Fig. 2
) that may lead to sub-
optimal outcomes. Additionally, supraglottoplasty should be carefully
considered in those with neurologic disease whose aspiration could
J. Carter et al./International Journal of Pediatric Otorhinolaryngology 86 (2016) 256–261
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