Clinical factors associated with surgical intervention and outcomes in pediatric laryngomalacia: A five-year tertiary care study from Eastern India.

OBJECTIVE

To evaluate clinical characteristics, associated comorbidities, management strategies, and factors associated with surgical intervention in children with laryngomalacia managed at a tertiary pediatric airway referral center in Eastern India.

METHODS

This retrospective cohort study included children aged 0-60 months diagnosed with laryngomalacia between January 2019 and December 2024 at Institute of Child Health. Diagnosis was confirmed by flexible nasopharyngolaryngoscopy. Clinical features, disease severity, feeding dysfunction, gastroesophageal reflux disease (GERD), synchronous airway lesions (SALs), management details, and outcomes were analyzed. Additional variables were extracted from institutional records following peer-review recommendations to improve methodological reporting. Factors associated with surgical intervention were evaluated using univariate analysis and exploratory multivariable analysis where statistically feasible.

RESULTS

A total of 68 children were included (male:female ratio 1.9:1). Median age at symptom onset was 2.5 months (IQR 1.5-4.0 months), and median age at diagnosis was 5 months (IQR 3-7 months). Feeding difficulty occurred in 47.1%, aspiration in 17.6%, failure to thrive in 22.1%, GERD in 30.9%, and SALs in 26.5%. Most children (82.4%) were successfully managed conservatively, while 17.6% required Supraglottoplasty. Fifty-nine children (86.8%) completed at least 12 months follow-up. Complete resolution of stridor occurred in 48/59 children (81.4%), and surgical success was observed in 10/12 children (83.3%). Feeding dysfunction and SALs were significantly associated with surgical intervention.

CONCLUSIONS

Most children with laryngomalacia improve with conservative management. However, feeding dysfunction and synchronous airway lesions may identify children at higher risk of requiring surgery. Early multidisciplinary airway evaluation may improve outcomes.