A Systematic Review of Laryngomalacia and Acid Reflux

Objective. To identify and appraise the evidence for an association between laryngomalacia (LM) and acid reflux through a systematic review of the existing literature. Data Sources. MEDLINE, EMBASE, the Cochrane Library, Google Scholar, and collected additional publications cited in bibliographies. Review Methods. Literature search by both authors with structured criteria to select studies evaluated for systematic review. The Oxford Centre for Evidence-Based Medicine (CEBM) guidelines were applied to assess study quality of evidence. Results. Twenty-seven studies, representing 1295 neonates with LM, were included. Levels of evidence varied from CEBM level 2a (n = 1) to 4 (n = 23). Although reflux definitions were diverse, overall reflux prevalence in this group was 59% (pooled odds ratio [OR] of 4 controlled studies = 1.15, P = .67). Further evidence supporting an association between reflux and LM included the ubiquity of acid reflux using dual-probe pH monitoring in children with LM (2 studies; n = 84), the increased prevalence of reflux in severe as compared with mild LM (3 studies; n = 237; pooled OR = 9.86, P < .0001), case series and reports of LM improvement with antireflux therapy (6 studies; n = 275), and histological evidence of reflux-related laryngeal inflammation in children with LM (2 studies; n = 18). Conclusion. The literature shows a coexistence between acid reflux and LM, but the evidence for a causal association is limited. In view of the widespread use of antireflux treatment in LM, a randomized controlled trial of antireflux medication vs placebo appears justified.