Congenital laryngomalacia is related to exercise-induced laryngeal obstruction in adolescence

• Published in: Archives of disease in childhood 2016-05, Vol.101 (5), p.443-448
• Main Authors: Hilland, Magnus, Røksund, Ola Drange, Sandvik, Lorentz, Haaland, Øystein, Aarstad, Hans Jørgen, Halvorsen, Thomas, Heimdal, John-Helge
• Format: Article
• Language: English
• Subjects: Adolescence; Adolescent; Adolescents; Airway Obstruction - etiology; Child; Child Health; Comorbidity; Epiglottis; Exercise; Exercise Test - adverse effects; Female; Fitness equipment; Follow-Up Studies; Health aspects; Heterogeneity; Hospitals; Humans; Infant; Infants; Laryngeal diseases; Laryngomalacia - congenital; Laryngomalacia - etiology; Laryngoscopy; Larynx - abnormalities; Male; Original; Patients; Physical Activities; Physical fitness; Respiratory diseases; Spirometry; Surveys and Questionnaires; Teenagers; Video Technology; Young Adult; Young Children
• ISSN: 0003-9888; 1468-2044
• DOI: 10.1136/archdischild-2015-308450

ObjectivesCongenital laryngomalacia (CLM) is the major cause of stridor in infants. Most cases are expected to resolve before 2 years of age, but long-term respiratory prospects are poorly described. We aimed to investigate if CLM was associated with altered laryngeal structure or function in later life.MethodsTwenty of 23 (87%) infants hospitalised at Haukeland University Hospital during 1990–2000 for CLM without comorbidities and matched controls were assessed at mean age 13 years. Past and current respiratory morbidity was recorded in a questionnaire, and spirometry performed according to standard quality criteria. Laryngoscopy was performed at rest and continuously throughout a maximal treadmill exercise test (continuous laryngoscopy exercise test (CLE-test)), and scored and classified in a blinded fashion according to preset criteria.ResultsIn the CLM group, laryngeal anatomy supporting CLM in infancy was described at rest in nine (45%) adolescents. Eleven (55%) reported breathing difficulties in relation to exercise, of whom 7 had similarities to CLM at rest and 10 had supraglottic obstruction during CLE-test. Overall, 6/20 had symptoms during exercise and similarities to CLM at rest and obstruction during CLE-test. In the control group, one adolescent reported breathing difficulty during exercise and two had laryngeal obstruction during CLE-test. The two groups differed significantly from each other regarding laryngoscopy scores, obtained at rest and during exercise (p=0.001 or less).ConclusionsCLM had left footprints that increased the risk of later exercise-induced symptoms and laryngeal obstruction. The findings underline the heterogeneity of childhood respiratory disease and the importance of considering early life factors.