Shivnani Deepa, Raman E V, Kurien Mary, Ram Gnanam, Amle Dnyanesh
Department of Otorhinolaryngology and Head & Neck Surgery, Children's Airway & Swallowing Center, Manipal Hospital, Bangalore, Karnataka India.
Department of Otorhinolaryngology, Pondicherry Institute of Medical Sciences, Puducherry, India.
Indian J Otolaryngol Head Neck Surg. 2023 Mar;75(1):151-158. doi: 10.1007/s12070-022-03307-7. Epub 2022 Dec 3.
Identifying surgical candidacy for the management of laryngomalacia is a challenge.
To develop a simple scoring system for surgical candidacy in laryngomalacia.
Eighteen years retrospective observational study of children with laryngomalacia (LM) clinically categorized into mild, moderate and severe LM and were analyzed for surgical candidacy.
There were 113 children (age ranging from 5 days to 14 months), 44% being mild, 30% moderate and 26% severe LM. None in mild, 32% in moderate, and all in severe LM had surgical intervention. Presence of stridor on feeding or crying and isolated type 1 or type 2 LM on laryngoscopy were significant indicators for conservative treatment (-< 0.0001). Moderate failure to thrive, retraction at rest/sleep, with low oxygen saturation while feeding/at rest were significantly higher in both moderate and severe groups with laryngoscopic evidence of combined type 1 and 2 in moderate LM ( < 00,001). Aspiration pneumonia, hospitalization, pectus and mean pulmonary arterial pressure of more than 25 mmHg with laryngoscopic findings of all three combined types were significantly higher in severe LM ( < 0.0001).A simple scoring system was then developed and it revealed that a score of 10 or more required surgical intervention.
A clinical scoring system is being reported for the first time in medical literature to identify 'the difficult to treat' subset within moderate laryngomalacia category simplifying decision making in its management for otolaryngologists and pediatricians as well as a referral criterion for pediatric otolaryngologists' services.
确定喉软化症治疗的手术适应症是一项挑战。
开发一种用于喉软化症手术适应症的简单评分系统。
对18年来临床分类为轻度、中度和重度喉软化症的儿童进行回顾性观察研究，并分析其手术适应症。
共有113名儿童（年龄从5天至14个月），44%为轻度喉软化症，30%为中度，26%为重度。轻度喉软化症患儿均未接受手术干预，中度患儿中有32%接受了手术，重度患儿全部接受了手术。喂食或哭闹时出现喘鸣以及喉镜检查显示为单纯1型或2型喉软化症是保守治疗的重要指标（P<0.0001）。中度和重度组中，中度发育不良、静息/睡眠时出现吸气凹陷、喂食/静息时血氧饱和度低且喉镜检查显示中度喉软化症合并1型和2型的情况显著更多（P<0.0001）。重度喉软化症患儿中，出现吸入性肺炎、住院、鸡胸以及平均肺动脉压超过25mmHg且喉镜检查显示三种类型均有的情况显著更多（P<0.0001）。随后开发了一个简单的评分系统，结果显示评分达到或超过10分需要进行手术干预。
医学文献首次报道了一种临床评分系统，用于识别中度喉软化症中“难治”的亚组，简化了耳鼻喉科医生和儿科医生在其治疗中的决策制定，同时也作为儿科耳鼻喉科服务的转诊标准。
