Change in swallow function after supraglottoplasty

Background: Laryngomalacia is the most common cause of stridor in infants. In patients with laryngomalacia severe enough to require surgical intervention, subjective feeding difficulty is commonly reported. We aim to describe change in diet and dysphagia after supraglottoplasty in patients with laryngomalacia. Methods: Retrospective case series at a tertiary care children’s hospital. Primary outcome was change in diet comparing before and after surgical treatment of laryngomalacia. Change in dysphagia was defined by results of video fluoroscopic swallow studies. Results: A total of 222 patients were included in this study. Preoperatively, 66 (30%) patients had diet restrictions. Thirty-one of 66 (47%) patients had a reduction in diet restrictions with 6 (9%) of these patients achieving a regular diet by last follow up. Seventeen (8%) patients had an increase in diet restriction after supraglottoplasty. This was temporary in most patients (n=13) with resolution over time (median 45 days, range 6 days–2 years). Four (2%) patients had permanent increase in diet restriction. Twenty-two (10%) patients had pre- and post-operative video fluoroscopic swallow study (VFSS). Five (23%) patients had temporary and 5 had long-term worsened dysphagia. Two had no change in dysphagia and the remaining 10 had immediate improvement in dysphagia. Conclusions: Supraglottoplasty is associated with reduction in diet restrictions in less than half of patients with preoperative diet restrictions. Transient increase in diet restrictions with associated worsening in dysphagia occurs in a small subset of patients after supraglottoplasty. This occurs in patients with and without preoperative diet restrictions. Preoperative and postoperative objective assessment of swallow function should be considered for all patients undergoing supraglottoplasty.