The Role of Acid Reflux Medications for Treatment of Laryngomalacia in Delaying Supraglottoplasty

Sunday, September 29, 2024

9:54 AM – 10:00 AM EDT

Location: MBCC, 225

Disclosure(s):

Habib G. Zalzal, MD:

faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Adam T. Hammer, Other:

faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

George H. Zalzal, MD:

faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Introduction: Anti-reflux medications are frequently used in the management of laryngomalacia-related respiratory complications with or without diagnosed gastroesophageal reflux disease (GERD). The goal of our study was to evaluate the impact of medical management of laryngomalacia using GERD medications on the need for eventual supraglottoplasty for treatment of laryngomalacia causing respiratory distress. It is our belief that in patients presenting with respiratory symptoms, acid reflux medication does not play a role in the management of patients with diagnosed laryngomalacia.

Methods: Retrospective cohort study of infants evaluated in an outpatient airway clinic at a tertiary care pediatric hospital. Database was queried for infants ( < 24 months) presenting with stridor, noisy breathing, snoring, apnea, or reflux from 2014 to 2023. Data extracted included chief complaint, symptoms, laryngomalacia severity, anti-reflux medication, surgical interventions, and other findings as applicable.

Results: The charts of 555 children (age 0.3-22.2 months) were analyzed, yielding three categories: observation (N = 380), trial of GERD medications (N = 89), and supraglottoplasty (N = 86). Baseline characteristics between the observation and GERD groups were non-significant aside from stridor presentation (55.8% vs 23.6%, p < 0.001), dysphagia (40.5% vs 75.3%, p < 0.001), and no previous trial of GERD medications (51.1% vs 15.9%, p < 0.001). Overall supraglottoplasty rate was 3.8% (18 out of 469) with no significant difference between the observation and GERD cohorts (3.4% vs 5.6%; p = 0.331). For all three group, the supraglottoplasty cohort was more likely to present with severe laryngomalacia (68.6%) compared to the observation (23.7%) and GERD cohorts (27.0%) (p < 0.001).

Conclusions: In the treatment of laryngomalacia causing stridor and respiratory distress, GERD medications do not significantly alter the course of management in children who do not have severe laryngomalacia noted on flexible laryngoscopy on initial presentation.

Presenting Author(s)

Habib G. Zalzal, MD

Assistant Professor
Children's National Hospital
Washington, DC, United States

Disclosure(s):
faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Co-Author(s)

AH

Adam T. Hammer

Medical Student
Children's National Medical Center
Washington, District of Columbia, United States

Disclosure(s):
faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.
AP

Alisha Pershad

Children's National Medical Center, United States

Disclosure information not submitted.
HB

Hengameh K. Behzadpour, MSHS

Clinical Research Coordinator
Children's National Medical Center
Washington, District of Columbia, United States

Disclosure information not submitted.
MR

Mohammad Rana, MBBS, MPH

United States

Disclosure information not submitted.

Senior Author(s)

GZ

George H. Zalzal, MD

Professor and Chief Emeritus-Otolaryngology
Children's National Medical Center
Washington, DC, United States

Disclosure(s):
faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.