New Numerical Score and Stepwise Algorithm for the Classification and Management of Laryngomalacia.

Introduction  The classification and management of laryngomalacia are challenging topics that are continuously updated and modified by pediatric airway surgeons. However, a numerical stratification of the patients to decide on the conservative management or intervention has not yet been established. Objective  To provide an easy approach to cases of laryngomalacia by adopting an updated scoring system with a stepwise management algorithm. Methods  We conducted a prospective study that included patients diagnosed with laryngomalacia over three years. The proposed symptom and history score was used to categorize patients into mild, moderate, and severe grades. Then, the examination and investigation scores designed were applied to the selected cases according to the management algorithm. Basic data from the patients and their flow throughout the study were assessed. Results  The study included 112 patients with a mean age of 4.3 ± 2.2 months. In total, 44 (39.3%) cases were considered mild, 48 (42.86%), moderate, and 20 (17.85%), severe. The examination score was used to assess 68 out of 112 patients, including all moderate and severe cases of laryngomalacia. All of the mild cases were followed up, and none required surgery. The investigation score was applied to 55 cases, including all the severe cases, as preoperative evaluation, and 35 out of 48 moderate cases. Conclusion  This newly proposed scoring system with the associated algorithm is an easily applicable way to deal with, classify, and properly manage laryngomalacia cases.