Polysolmnography and laryngomalacia severity
Reviewed by Louisa Ferguson

Laryngomalacia represents the single most common cause of stridor in infants. Most cases are self-resolving, but a proportion of children will require surgical intervention. This group aimed to analyse the efficacy of polysomnography in determining the severity of laryngomalacia in paediatric patients. Twenty-three patients were involved in the study and all patients underwent complete PSG prior to evaluation and severity scoring for laryngomalacia. The scoring system chosen was proposed by Sivan et al. in 2006 and assigns patients both a clinical score based on history, physical exam and flexible laryngoscopy. The patients included in the study (n=23) had an average age of 7.1 months at time of initial evaluation. 95.7% (22/23) of study participants had moderate to severe obstructive sleep apnoea. 69.6% (16/23) of study participants subsequently underwent supraglottoplasty. The average AHI of those undergoing supraglottoplasty was not statistically different from those who did not. Supraglottoplasty was recommended in those patients with cyanosis, failure to thrive/inability to feed, severe stridor and or classic flexible laryngoscopy findings. It was also offered to all children with severe sleep apnoea, although many of those patients opted for observation given the natural history of laryngomalacia. Scores derived from history alone in those who went to surgery were significantly higher than those that did not, but the scores derived from physical exam alone were not significantly higher in those that went to surgery. Determining which children to take to theatre is often operator dependent, and as can be inferred from these results is largely based on history. Although in this study preoperative PSG parameters did not predict the need for surgical intervention, further investigation into the relationship between PSG findings and laryngomalacia could help guide management in a more structured way.

Utility of polysomnography in determination of laryngomalacia severity.
Weinstein JE, Lawlor CM, Wu EL, Rodriguez KH.
INTERNATIONAL JOURNAL OF PEDIATRIC OTORHINOLARYNGOLOGY
2017;93:145-9.