Am J Otolaryngol Head Neck Surg | Volume 2, Issue 9 | Research Article | Open Access

Measuring Inhalational Glottal Opening to Evaluate Surgical Outcomes in Adult-onset Laryngomalacia: A Novel Method for a Rare Entity

Erin A Harvey1, Charles Farbos De Luzan1, Kathleen M Sarber2,3, Sid Khosla1 and Rebecca J Howell1*

1Department of Otolaryngology, Head and Neck Surgery, University of Cincinnati College of Medicine, USA 2Department of Surgery, Uniformed Services University of the Health Sciences, USA 3Department of Pulmonary Medicine, Cincinnati Children’s Hospital Medical Center, USA

*Correspondance to: Rebecca J Howell 

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Introduction: Laryngomalacia (LM) is supraglottic collapse on inspiration, causing temporary airway obstruction. Congenital laryngomalacia is a well-described primary disorder in infants. However, adult-onset LM is rarely discussed in the literature. Adult LM can be acquired iatrogenically via trauma or neurodegenerative disease, or it may manifest as paradoxical vocal fold motion, methacholine-resistant asthma, or obstructive sleep apnea. We present the largest cohort of single institution adult-onset LM. Methods: Patients were selected for retrospective review using the Voice Swallowing, and Airway database at the University of Cincinnati over a two-year period (March 2016 to May 2018). Charts were reviewed for patient characteristics, medical comorbidities, chief complaint, pulmonary function testing, polysomnography testing, and patient rated Dyspnea Index (DI). Inhalation images were reviewed and selected from recorded endoscopic exams by senior author (RH). Matlab® program was used to compute glottal opening Area (A) and Length (L) from manually delineating opening contours. A/L2 was considered for each image as a non-dimensional comparison value between pre- and post-operative inhalational endoscopies. Results: The study included 19 patients: mean age 49.4 years (range 16-97), 63% were female and 53% (BMI>30) considered obese. Sixteen (84%) presented with dyspnea and 10 (53%) with cough. Patients were categorized into acquired (n=14) and iatrogenic (n=5). Eleven patients underwent surgery (arytenoidectomy, supraglottoplasty, with/without staging) with an improvement in DI by 7.6 (SD=5.8). 90% of patient's demonstrated increased postoperative inhalation glottal opening A/ L2 compared to pre-operative value. Conclusion: Adult-onset LM should be considered in patients presenting with dyspnea, cough or OSA like symptoms. We describe the use of inhalational glottal opening as a novel measure to describe pre-and post-operative LM surgical outcomes.


Laryngomalacia; Supraglottoplasty; Obstructive sleep apnea; Inhalational glottal opening


Harvey EA, De Luzan CF, Sarber KM, Khosla S, Howell RJ. Measuring Inhalational Glottal Opening to Evaluate Surgical Outcomes in Adult-onset Laryngomalacia: A Novel Method for a Rare Entity. Am J Otolaryngol Head Neck Surg. 2019; 2(9): 1073.

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