The Open Anesthesia Journal

Formerly: The Open Anesthesiology Journal

ISSN: 2589-6458 ― Volume 13, 2019

Sleep Disordered Breathing May Signal Laryngomalacia

Christine M. Clark1, Dale S. DiSalvo2, Jansie Prozesky3, *, Michele M. Carr4
1 The Pennsylvania State University, College of Medicine, Hershey, PA, USA
2 Department of Anesthesiology, University of Rochester Medical Center, Rochester, NY, USA
3 Department of Anesthesiology and Perioperative Medicine, Division of Pediatric Anesthesia, The Pennsylvania University, College of Medicine, Hershey, PA, USA
4 Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, and Department of Pediatrics, The Pennsylvania University, College of Medicine, Hershey, PA, USA



Pediatric anesthesiologists are often confronted with children with sleep-disordered breathing (SDB) presenting for tonsillectomy and/or anesthesia. The typical patient has symptoms of obstructive sleep apnea (OSA) with enlarged tonsils; however, a subset of patients may have underlying laryngomalacia (LM) without tonsillar hypertrophy. Both OSA and LM significantly increase the risk of intra- and postoperative airway obstruction and sensitivity to narcotics. The prevalence of LM may be underestimated, because direct laryngoscopy (DL) is not routinely performed in the diagnostic evaluation of patients with SDB who lack tonsillar hypertrophy.


To identify the prevalence and DL findings in pediatric patients with SDB without tonsillar hypertrophy.


Retrospective chart review of 108 patients with SDB who underwent general anesthesia for adenotonsillectomy (TA) or adenoidectomy with concomitant DL. The following data were collected: demographic information, medical comorbidities, polysomnography results, anesthetic techniques, and postoperative complications.


94.5% of children had DL findings consistent with LM, including a retropositioned epiglottis and short aryepiglottic folds. Postglottic edema was observed in 42.2%, and these patients were significantly more likely to have a diagnosis of gastroesophageal reflux (P=0.023). 57.8% had vocal cord edema. 75.3% of children who received routine postoperative follow-up care experienced complete symptom resolution. Postoperative complications following discharge from hospital occurred in 12.4% of patients, and 15.7% underwent supraglottoplasty for continued SDB symptoms after TA or adenoidectomy.


A substantial proportion of patients with SDB who lacked tonsillar hypertrophy had findings consistent with LM, suggesting that the larynx may be the primary site of upper airway obstruction in these patients. This has significant implications in terms of perioperative management. The majority of patients with SDB had symptomatic improvement following TA or adenoidectomy; however, a subset required further surgical intervention with supraglottoplasty.

Keywords: Laryngomalacia, Sleep-disordered breathing, Denotonsillectomy, Direct laryngoscopy, Obstructive sleep apnea, Perioperative period.

Article Information

Identifiers and Pagination:

Year: 2017
Volume: 11
First Page: 68
Last Page: 74
Publisher Id: TOATJ-11-68
DOI: 10.2174/1874321801711010068

Article History:

Received Date: 07/03/2017
Revision Received Date: 22/05/2017
Acceptance Date: 07/07/2017
Electronic publication date: 02/08/2017
Collection year: 2017

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© 2017 Clark et al.

open-access license: This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International Public License (CC-BY 4.0), a copy of which is available at: ( This license permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

* Address correspondence to this author at the Department of Anesthesiology and Perioperative Medicine, Division of Pediatric Anesthesia, The Pennsylvania State University, College of Medicine, Hershey, USA; Tel: 717-531-4264; Fax: 717-531-4110; E-mail: jprozesky@pennstatehealth.


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