{"title":"胃酸反流药物与婴儿喉软化症声门上成形术的关系","authors":"Habib Zalzal, Alisha Pershad, Hengameh Behzadpour, Md Sohel Rana, George Zalzal","doi":"10.1001/jamaoto.2025.1201","DOIUrl":null,"url":null,"abstract":"<p><strong>Importance: </strong>Acid suppression therapy is frequently administered to infants with laryngomalacia presenting with stridor despite limited evidence in the literature reporting its efficacy for this subset of patients.</p><p><strong>Objective: </strong>To evaluate the frequency of supraglottoplasty in infants with nonsevere laryngomalacia treated with gastroesophageal reflux disease (GERD) medications.</p><p><strong>Design, setting, and participants: </strong>This retrospective cohort study included infants younger than 6 months with a clinical diagnosis of nonsevere laryngomalacia initially managed with either watchful waiting or GERD medications. Patients were recruited from 2014 to 2023 to a pediatric otolaryngology airway clinic at a tertiary care pediatric hospital.</p><p><strong>Main outcomes and measures: </strong>The primary outcome was the frequency of supraglottoplasty following nonsurgical management. Patients with nonsevere laryngomalacia were divided into 2 groups based on whether their laryngomalacia was managed with GERD medication therapy or observation alone. The aim was to assess the difference in supraglottoplasty rates between these 2 groups.</p><p><strong>Results: </strong>The medical records of 395 infants younger than 6 months (171 female, 224 male) with nonsevere laryngomalacia managed with observation after their initial otolaryngology evaluation were analyzed: observation (n = 320) and trial of GERD medications (n = 75). Baseline characteristics between the observation and GERD medication groups were similar. The overall supraglottoplasty rate was 4.1% (16/395), with a small increase in the use of surgical treatment between the observation and GERD medication cohorts (3.4% vs 6.7%; difference, -3.2% [95% CI, -10% to 3.6%]). The imprecision in the estimate prevents making a definitive conclusion regarding the observed difference.</p><p><strong>Conclusions: </strong>This study found that rates of supraglottoplasty in infants with nonsevere laryngomalacia with GERD managed with GERD medications were similar to those without reflux managed with watchful waiting. Female sex and severity of laryngomalacia based on endoscopic examination were the best predictors of receipt of supraglottoplasty after a period of watchful waiting.</p>","PeriodicalId":14632,"journal":{"name":"JAMA otolaryngology-- head & neck surgery","volume":" ","pages":"693-698"},"PeriodicalIF":5.6000,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12123530/pdf/","citationCount":"0","resultStr":"{\"title\":\"Association Between Acid Reflux Medication and Supraglottoplasty in Infant Laryngomalacia.\",\"authors\":\"Habib Zalzal, Alisha Pershad, Hengameh Behzadpour, Md Sohel Rana, George Zalzal\",\"doi\":\"10.1001/jamaoto.2025.1201\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Importance: </strong>Acid suppression therapy is frequently administered to infants with laryngomalacia presenting with stridor despite limited evidence in the literature reporting its efficacy for this subset of patients.</p><p><strong>Objective: </strong>To evaluate the frequency of supraglottoplasty in infants with nonsevere laryngomalacia treated with gastroesophageal reflux disease (GERD) medications.</p><p><strong>Design, setting, and participants: </strong>This retrospective cohort study included infants younger than 6 months with a clinical diagnosis of nonsevere laryngomalacia initially managed with either watchful waiting or GERD medications. Patients were recruited from 2014 to 2023 to a pediatric otolaryngology airway clinic at a tertiary care pediatric hospital.</p><p><strong>Main outcomes and measures: </strong>The primary outcome was the frequency of supraglottoplasty following nonsurgical management. Patients with nonsevere laryngomalacia were divided into 2 groups based on whether their laryngomalacia was managed with GERD medication therapy or observation alone. The aim was to assess the difference in supraglottoplasty rates between these 2 groups.</p><p><strong>Results: </strong>The medical records of 395 infants younger than 6 months (171 female, 224 male) with nonsevere laryngomalacia managed with observation after their initial otolaryngology evaluation were analyzed: observation (n = 320) and trial of GERD medications (n = 75). Baseline characteristics between the observation and GERD medication groups were similar. The overall supraglottoplasty rate was 4.1% (16/395), with a small increase in the use of surgical treatment between the observation and GERD medication cohorts (3.4% vs 6.7%; difference, -3.2% [95% CI, -10% to 3.6%]). The imprecision in the estimate prevents making a definitive conclusion regarding the observed difference.</p><p><strong>Conclusions: </strong>This study found that rates of supraglottoplasty in infants with nonsevere laryngomalacia with GERD managed with GERD medications were similar to those without reflux managed with watchful waiting. 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引用次数: 0
摘要
重要性:抑酸疗法经常用于以喘鸣为表现的喉软化症婴儿,尽管文献中报道其对这部分患者的疗效的证据有限。目的:评价经胃食管反流病(GERD)药物治疗的非重度喉软化患儿声门上成形术的发生率。设计、环境和参与者:这项回顾性队列研究包括6个月以下的婴儿,临床诊断为非严重喉软化,最初采用观察等待或反流药物治疗。从2014年到2023年,患者被招募到一家三级护理儿科医院的儿科耳鼻喉科气道诊所。主要结果和措施:主要结果是非手术治疗后的声门上成形术的频率。非重度喉软化患者根据喉软化是否采用反流药物治疗或单独观察分为两组。目的是评估这两组间声门上成形率的差异。结果:对395例6月龄以下非重度喉软化患儿(女171例,男224例)进行初步耳鼻喉科评估后进行观察的医疗记录进行分析:观察(n = 320)和胃食管反流药物试验(n = 75)。观察组和胃反流药物组的基线特征相似。总的门上成形术率为4.1%(16/395),在观察组和胃食管反流药物组之间,手术治疗的使用略有增加(3.4% vs 6.7%;差异为-3.2% [95% CI, -10%至3.6%])。由于估计不精确,无法对观察到的差异作出明确的结论。结论:本研究发现,非严重喉软化合并反流的婴儿,采用反流药物治疗的声门上成形术的比例与没有反流的婴儿采用观察等待治疗的比例相似。女性性别和基于内窥镜检查的喉软化严重程度是在观察等待一段时间后接受声门上成形术的最佳预测因素。
Association Between Acid Reflux Medication and Supraglottoplasty in Infant Laryngomalacia.
Importance: Acid suppression therapy is frequently administered to infants with laryngomalacia presenting with stridor despite limited evidence in the literature reporting its efficacy for this subset of patients.
Objective: To evaluate the frequency of supraglottoplasty in infants with nonsevere laryngomalacia treated with gastroesophageal reflux disease (GERD) medications.
Design, setting, and participants: This retrospective cohort study included infants younger than 6 months with a clinical diagnosis of nonsevere laryngomalacia initially managed with either watchful waiting or GERD medications. Patients were recruited from 2014 to 2023 to a pediatric otolaryngology airway clinic at a tertiary care pediatric hospital.
Main outcomes and measures: The primary outcome was the frequency of supraglottoplasty following nonsurgical management. Patients with nonsevere laryngomalacia were divided into 2 groups based on whether their laryngomalacia was managed with GERD medication therapy or observation alone. The aim was to assess the difference in supraglottoplasty rates between these 2 groups.
Results: The medical records of 395 infants younger than 6 months (171 female, 224 male) with nonsevere laryngomalacia managed with observation after their initial otolaryngology evaluation were analyzed: observation (n = 320) and trial of GERD medications (n = 75). Baseline characteristics between the observation and GERD medication groups were similar. The overall supraglottoplasty rate was 4.1% (16/395), with a small increase in the use of surgical treatment between the observation and GERD medication cohorts (3.4% vs 6.7%; difference, -3.2% [95% CI, -10% to 3.6%]). The imprecision in the estimate prevents making a definitive conclusion regarding the observed difference.
Conclusions: This study found that rates of supraglottoplasty in infants with nonsevere laryngomalacia with GERD managed with GERD medications were similar to those without reflux managed with watchful waiting. Female sex and severity of laryngomalacia based on endoscopic examination were the best predictors of receipt of supraglottoplasty after a period of watchful waiting.
期刊介绍:
JAMA Otolaryngology–Head & Neck Surgery is a globally recognized and peer-reviewed medical journal dedicated to providing up-to-date information on diseases affecting the head and neck. It originated in 1925 as Archives of Otolaryngology and currently serves as the official publication for the American Head and Neck Society. As part of the prestigious JAMA Network, a collection of reputable general medical and specialty publications, it ensures the highest standards of research and expertise. Physicians and scientists worldwide rely on JAMA Otolaryngology–Head & Neck Surgery for invaluable insights in this specialized field.