Anatomical Subtypes and Swallowing Dysfunction as Predictors of Disease Severity in Pediatric Laryngomalacia: A Cohort Study

Anatomical Subtypes and Swallowing Dysfunction as Predictors of Disease Severity in Pediatric Laryngomalacia: A Cohort Study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Anatomical Subtypes and Swallowing Dysfunction as Predictors of Disease Severity in Pediatric Laryngomalacia: A Cohort Study Sally M Adel, Alaa Eldeen Hazem Gaafar, Heba Mahmoud Taha Elwishahi, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8606311/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 9 You are reading this latest preprint version Abstract Background Laryngomalacia (LM) is the most common congenital laryngeal anomaly. While typically self-limiting, it increasingly presents as a complex aerodigestive disorder involving swallowing dysfunction and gastroesophageal reflux. Our aim is to evaluate the prevalence of swallowing abnormalities in LM, correlate anatomical subtypes and swallowing function with disease severity, and identify prognostic factors for surgical intervention. Methods This observational cohort study included 138 pediatric patients (aged ≤ 24 months) with endoscopically confirmed LM at a tertiary academic center between March 2022 and March 2024. Patients underwent flexible fiberoptic laryngoscopy and/or bronchoscopy and were classified by anatomical type (Hollinger and Konior Types A, B, C). Swallowing function was assessed clinically and via Fiberoptic Endoscopic Evaluation of Swallowing (FEES) using the Penetration-Aspiration Scale (PAS). Disease severity was graded using International Pediatric ORL Group (IPOG) criteria. Results The cohort (mean age 6.6 ± 6.09 months; 55.1% male) exhibited anatomical types: A (30.4%), B (39.1%), and C (30.4%). Swallowing abnormalities were present in 65.2% of patients. Type B morphology was strongly associated with severe disease (p < 0.001) and severe stridor (p < 0.001). Clinical swallowing abnormalities were significantly associated with higher disease severity (p < 0.001). Supraglottoplasty was required in 13.0% (n = 18) of the cohort; notably, 100% of surgical candidates had Type B anatomy. Synchronous airway lesions, primarily laryngeal clefts (15.2%) and tracheomalacia (10.9%), were frequent comorbidities. Conclusion Type B laryngomalacia is a distinct prognostic indicator for severe disease and the need for surgical intervention. Swallowing dysfunction is highly prevalent and correlates with disease severity, necessitating systematic instrumental assessment in management algorithms. Laryngomalacia Dysphagia Supraglottoplasty Pediatric Airway Fiberoptic Endoscopic Evaluation of Swallowing (FEES) Aspiration. Full Text Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Editorial decision: Revision requested 27 Feb, 2026 Reviews received at journal 27 Feb, 2026 Reviews received at journal 26 Feb, 2026 Reviewers agreed at journal 26 Feb, 2026 Reviewers agreed at journal 26 Feb, 2026 Reviewers invited by journal 28 Jan, 2026 Editor assigned by journal 21 Jan, 2026 Submission checks completed at journal 20 Jan, 2026 First submitted to journal 14 Jan, 2026 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8606311","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":581983374,"identity":"16c11603-5b0f-4812-83f5-00347a80f941","order_by":0,"name":"Sally M Adel","email":"data:image/png;base64,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","orcid":"","institution":"Alexandria University","correspondingAuthor":true,"prefix":"","firstName":"Sally","middleName":"M","lastName":"Adel","suffix":""},{"id":581983375,"identity":"9834cc81-30c5-46bc-a042-acc5ef3ef2eb","order_by":1,"name":"Alaa Eldeen Hazem Gaafar","email":"","orcid":"","institution":"Alexandria University","correspondingAuthor":false,"prefix":"","firstName":"Alaa","middleName":"Eldeen Hazem","lastName":"Gaafar","suffix":""},{"id":581983376,"identity":"8988e5ce-1c2d-4f0b-b74f-6b97532e211b","order_by":2,"name":"Heba Mahmoud Taha Elwishahi","email":"","orcid":"","institution":"Alexandria University","correspondingAuthor":false,"prefix":"","firstName":"Heba","middleName":"Mahmoud Taha","lastName":"Elwishahi","suffix":""},{"id":581983377,"identity":"6e491701-2e05-4d85-984e-15648d199815","order_by":3,"name":"Mohamed M Abogabal","email":"","orcid":"","institution":"Alexandria University","correspondingAuthor":false,"prefix":"","firstName":"Mohamed","middleName":"M","lastName":"Abogabal","suffix":""},{"id":581983378,"identity":"04186c20-1e23-4881-bd12-492dcd3be17c","order_by":4,"name":"Abdelmoneam Belal Mahmoud","email":"","orcid":"","institution":"Alexandria University","correspondingAuthor":false,"prefix":"","firstName":"Abdelmoneam","middleName":"Belal","lastName":"Mahmoud","suffix":""}],"badges":[],"createdAt":"2026-01-15 03:08:16","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-8606311/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-8606311/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":101752226,"identity":"f8f80f6e-a53b-4a97-b043-6eeec5161fdd","added_by":"auto","created_at":"2026-02-03 10:26:11","extension":"pdf","order_by":1,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":545065,"visible":true,"origin":"","legend":"","description":"","filename":"AnatomicalSubtypesandSwallowingDysfunctionasPredictorsofDiseaseSeverityinPediatricLaryngomalaciaACohortStudy1.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8606311/v1_covered_0e004814-8b16-43a6-aec0-880d0478b289.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Anatomical Subtypes and Swallowing Dysfunction as Predictors of Disease Severity in Pediatric Laryngomalacia: A Cohort Study","fulltext":[],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":false,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":true,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":true,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"the-egyptian-journal-of-bronchology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"","sideBox":"Learn more about [The Egyptian Journal of Bronchology](https://ejb.springeropen.com/)","snPcode":"43168","submissionUrl":"https://submission.nature.com/new-submission/43168/3","title":"The Egyptian Journal of Bronchology","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Springer Open","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Laryngomalacia, Dysphagia, Supraglottoplasty, Pediatric Airway, Fiberoptic Endoscopic Evaluation of Swallowing (FEES), Aspiration.","lastPublishedDoi":"10.21203/rs.3.rs-8606311/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8606311/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eLaryngomalacia (LM) is the most common congenital laryngeal anomaly. While typically self-limiting, it increasingly presents as a complex aerodigestive disorder involving swallowing dysfunction and gastroesophageal reflux. Our aim is to evaluate the prevalence of swallowing abnormalities in LM, correlate anatomical subtypes and swallowing function with disease severity, and identify prognostic factors for surgical intervention.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eThis observational cohort study included 138 pediatric patients (aged\u0026thinsp;\u0026le;\u0026thinsp;24 months) with endoscopically confirmed LM at a tertiary academic center between March 2022 and March 2024. Patients underwent flexible fiberoptic laryngoscopy and/or bronchoscopy and were classified by anatomical type (Hollinger and Konior Types A, B, C). Swallowing function was assessed clinically and via Fiberoptic Endoscopic Evaluation of Swallowing (FEES) using the Penetration-Aspiration Scale (PAS). Disease severity was graded using International Pediatric ORL Group (IPOG) criteria.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eThe cohort (mean age 6.6\u0026thinsp;\u0026plusmn;\u0026thinsp;6.09 months; 55.1% male) exhibited anatomical types: A (30.4%), B (39.1%), and C (30.4%). Swallowing abnormalities were present in 65.2% of patients. Type B morphology was strongly associated with severe disease (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) and severe stridor (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Clinical swallowing abnormalities were significantly associated with higher disease severity (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Supraglottoplasty was required in 13.0% (n\u0026thinsp;=\u0026thinsp;18) of the cohort; notably, 100% of surgical candidates had Type B anatomy. Synchronous airway lesions, primarily laryngeal clefts (15.2%) and tracheomalacia (10.9%), were frequent comorbidities.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eType B laryngomalacia is a distinct prognostic indicator for severe disease and the need for surgical intervention. Swallowing dysfunction is highly prevalent and correlates with disease severity, necessitating systematic instrumental assessment in management algorithms.\u003c/p\u003e","manuscriptTitle":"Anatomical Subtypes and Swallowing Dysfunction as Predictors of Disease Severity in Pediatric Laryngomalacia: A Cohort Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-01-30 19:51:02","doi":"10.21203/rs.3.rs-8606311/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-02-27T21:26:32+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-02-27T21:25:42+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-02-27T01:26:48+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"100841289544413760200673137098204448196","date":"2026-02-27T01:14:51+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"193036430733140113950894502497970672259","date":"2026-02-26T15:09:14+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-01-28T17:50:41+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-01-21T05:43:56+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-01-20T22:58:39+00:00","index":"","fulltext":""},{"type":"submitted","content":"The Egyptian Journal of Bronchology","date":"2026-01-15T02:55:53+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"the-egyptian-journal-of-bronchology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"","sideBox":"Learn more about [The Egyptian Journal of Bronchology](https://ejb.springeropen.com/)","snPcode":"43168","submissionUrl":"https://submission.nature.com/new-submission/43168/3","title":"The Egyptian Journal of Bronchology","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Springer Open","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"a0c263eb-f62c-4728-9c11-17a05299d351","owner":[],"postedDate":"January 30th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-04-01T06:08:16+00:00","versionOfRecord":[],"versionCreatedAt":"2026-01-30 19:51:02","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8606311","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8606311","identity":"rs-8606311","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}