Nghiên cứu đặc điểm lâm sàng, cận lâm sàng của mềm sụn thanh quản ở trẻ em tại Bệnh viện Nhi Đồng 2

Abstract

Background: Laryngomalacia (LM) is the most common cause of congenital stridor, as the tissue supporting the larynx and epiglottis prolapse into the airway during inspiration. Most children with laryngomalacia have mild symptoms, which subside by the time the child is 18-24 months old. Severe disease affects breathing, circulation, psychomotor development, increased frequency, length of hospital stay, and even death. In the past, the examina­tion and evaluation of the larynx in children was often difficult because the children were uncooperative. Today, with the advancement of flexible endoscopy, there are more advantages than direct endoscopy under anesthesia. In our country, up to now, there have been a few studies on laryngomalacia, but there is still no consensus on clas­sifying laryngomalacia in children, as well as comparing endoscopic images with clinical morphology, surveying patients with the comorbidities affect the severity of laryngomalacia is less concerned. Objectives: The study aims to investigate the clinical features, endoscopic images ofLM, and the relationship of comorbidities associated with the severity ofLM. Methods: Case series study. All inpatients and outpatients had LM managed from June 2020 to August 2022 at Children's Hospital 2. Results: Mean age was 7.5 ± 2.9 months, the highest rate of group >3-18 months (75.6%). The group > 18 months had 100% mild. The rate of malnutrition is accounted for 18.6%. The rate of premature birth and low birth weight are accounted for 25.2%. Typical laryngeal stridor (100%), difficulty suckling, dysphagia, aspiration, and chest deformity are only seen in severe cases. According to Thompson classification, LM is mild (87.2%), moderate (4.7%), severe (8.1%). According to the Olney classification, LM type I (69.8%), type II (15.1%), type III (7%), mixed type (8.1%). Comorbidities are accounted for 37.2%, of which laryngopharyngeal reflux was the most common comorbidity, followed by pneumonia (24.4%), congenital heart disease (3.5%), neurological abnor­malities (4.7%), Down syndrome (2.3%). Moderate and severe LM had 100% higher LPR than mild LM (28%), LPR in group with comorbidities (62.5%) were higher than group without comorbidities (37.5%), The difference was statistically significant (c²; p=0.002). Associated with airway disease (26.7%), in which hypoglottic stenosis and tracheomalacia were the most common (9.3%). Airway disease was associated with severe LM (85.7%), moderate (50%), mild (20%). Conclusions: LM is usually mild (87.2%). Thompson's classification of severity according to clinical symptoms was not statistically different from Olney's endoscopic classification (c²; p = 0.2). Various comorbidities, especially airway disease, influence the prognosis of severe disease.