Tohoku J. Exp. Med., 2013 May, 230(1)

Acquired Idiopathic Laryngomalacia Treated by Laser Supraglottic Laryngoplasty

AI KAWAMOTO,¹ YUKIO KATORI,¹ YOHEI HONKURA,¹ MASAKI OGURA,¹ YOSHITAKA TAKANASHI² and TOSHIMITSU KOBAYASHI²

¹Division of Otorhinolaryngology, Sendai City Hospital, Sendai, Miyagi, Japan
²Department of Otorhinolaryngology and Head and Neck Surgery, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan

Laryngomalacia is the most common cause of stridor in neonates and infants, where the soft cartilages and tissues surrounding the upper larynx collapse inward during respiration. On the other hand, acquired idiopathic laryngomalacia in adults is quite rare, but should be borne in mind for differential diagnosis of upper airway distress. Allergic factors may cause airway distress, but have not been highlighted previously as the background of laryngomalacia. In this report, we describe two patients with acquired idiopathic laryngomalacia with reference to allergic rhinitis and high serum levels of immunoglobulin E. The first patient was a 16-year-old female who presented with inspiratory stridor and dyspnea due to attachment between the epiglottis and bilateral arytenoids, and the second patient was an 18-year-old male who also presented with inspiratory stridor due to attachment between the epiglottis and posterior pharyngeal wall. The respiratory function of both patients was within the normal range but the inspiratory stridor interfered with daily life. Laryngomicrosurgery was performed in both patients using a CO₂ laser to remove the arytenoid mucosa in the first patient, and to remove the tip of the epiglottis in the second. Both patients were followed up while receiving oral anti-allergic agents. Laser supraglottic laryngoplasty to remove the vibrating excess tissue was effective for resolving the symptoms. However, recurrence occurred three times in the first patient, and inferior turbinotomy to improve nasal respiration was useful for diminishing the symptoms.

keywords —— acquired laryngomalacia; allergic rhinitis; inspiratory stridor; serum immunoglobulin E; supraglottic laryngoplasty

© 2013 Tohoku University Medical Press

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Tohoku J. Exp. Med., 2013, 230, 43-47

Correspondence: Yukio Katori, M.D., Ph.D., Division of Otorhinolaryngology, Sendai City Hospital, 3-1, Shimizukoji, Wakabayashi, Sendai 984-8501, Japan.

e-mail: entsendai@yahoo.co.jp