Late-onset laryngomalacia - A variant of disease
Late-onset laryngomalacia - A variant of disease
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DOI：
10.1001/archoto.2007.17
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发表时间：
2008-01-01
影响因子：
--
通讯作者：
Thompson, Dana M.
中科院分区：
文献类型：
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作者：
Richter, Gresham T.;Rutter, Michael J.;Thompson, Dana M.
前言：目的：鉴定和描述其特征。在一群年龄较大的儿童中发现了喉软化症(LM)，目的是提供一种诊断和管理这些患者的方法。喉软化症是一种常见的先天性疾病，其特征是喉音张力降低，声门上塌陷，在吸气时发出刺耳的声音，在较大的儿童中很少见。设计：对1998-2005年间有LM证据的大龄儿童进行前瞻性收集和回顾性评估。地点：两家三级儿科机构。患者：前瞻性收集239例LM患者，包括222例先天性LM和17例2岁以上且无既往疾病或症状病史的LM-晚发型LM(平均发病年龄6.6岁)。干预：声门上整形。主要观察指标：症状改善。结果：根据症状复杂程度将晚发型LM分为3类；表现为进食障碍(n=7，平均发病年龄3.3岁)、睡眠障碍(n=7，平均发病年龄6.3岁)和运动性(n=3，平均发病年龄15岁)的患者。剧烈活动期间，除运动性肌萎缩侧索硬化症患者外，很少出现颤音。所有患者在鼻咽内窥镜检查中均发现有明显的环状软骨冗余和脱垂。未发现典型的先天性会厌会厌皱折或会厌后曲的解剖特征。没有患者有神经肌肉疾病的病史。所有患者均行临床治愈(平均随访时间7.4个月)。5例睡眠障碍的LM患者先行腺扁桃体切除术。这并没有改善症状，这些患者表现出LM是梗阻的证据。结论：内科医生应该考虑将晚发型LM作为幼儿喂养困难、儿童睡眠呼吸暂停和青少年运动不耐受的潜在原因。就像在患有LM的婴儿中一样，声门上成形术可以改善迟发性疾病。
Objective: To identify and describe the features. of laryngomalacia (LM) in a cohort of older children, with the goal of providing an approach to diagnosis and management of these patients. Laryngomalacia is a common congenital disorder characterized by decreased laryngeal tone,'supraglottic collapse, and stridor during inspiration and is rarely seen in older children. However, the presence of LM in this population may be obscured by related but uncommon clinical features.Design: Prospective collection and retrospective evaluation of older children with evidence of LM from 1998 to 2005.Setting: Two tertiary pediatric institutions.Patients: Prospective data collection of 239 patients with LM, including 222 with congenital LM and 17 diagnosed as having LM when they were older than 2 years and without a medical history of prior disease or symptoms-late-onset LM (mean age at onset, 6.6 years).Intervention: Supraglottoplasty.Main Outcome Measure: Symptom improvement.Results: Patients with late-onset LM were classified into 3 categories according to their symptom complex; those presenting with feeding-disordered LM (n=7; mean age at onset, 3.3 years), sleep-disordered LM (n=7; mean age at onset, 6.3 years), and exercise-induced LM (n=3; mean age at onset, 15 years). Stridor was rarely present except in patients with exercise-induced LM during strenuous activity. Profound arytenoid redundancy and prolapse was discovered in all patients during nasolaryngeal endoscopy. Typical anatomic features of congenital LM (shortened aryepiglottic folds or retroflexed epiglottis) were not discovered. No patient had a history of neuromuscular disease. Supra-arytenoid reduction (supraglottoplasty) led to clinical cure in all patients (mean duration of follow-up, 7.4 months). Prior adenotonsillectomies were performed in 5 patients with sleep-disordered LM. This did not improve symptoms, and these patients displayed evidence of LM as the source of obstruction.Conclusions: Physicians should consider late-onset LM as a potential cause of feeding difficulties in toddlers, sleep apnea in children, and exercise intolerance in teenagers. As in infants with LM, supraglottoplasty improves late-onset disease.