International Journal of Pediatric Otorhinolaryngology 139 (2020) 110464 Available online 24 October 2020 0165-5876/© 2020 Elsevier B.V. All rights reserved. The prevalence of swallowing dysfunction in children with laryngomalacia: a systematic review Hussein Jaffal a , Andre Isaac a, b , Wendy Johannsen c , Sandra Campbell d , Hamdy G. El-Hakim a, b, * a Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Alberta and the Stollery Children’s Hospital, Edmonton, Alberta, Canada b Division of Pediatric Surgery, Department of Pediatrics, University of Alberta and the Stollery Children’s Hospital, Edmonton, Alberta, Canada c Outpatient Feeding & Swallowing Service, Departments of Surgery & Pediatrics, University of Alberta and the Stollery Children’s Hospital, Edmonton, Alberta, Canada d Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada A R T I C L E INFO Keywords: Laryngomalacia Swallowing dysfunction Pediatric Fiberoptic endoscopic evaluation of swallowing Videofuoroscopic swallowing study ABSTRACT Objectives: Laryngomalacia (LM) is commonly diagnosed in infants and children with upper aerodigestive symptoms. In the literature, the focus has been on the respiratory impairment, with fewer studies addressing swallowing dysfunction (SwD). The objective of this study is to systematically review the literature for evidence on the prevalence of SwD in children diagnosed with LM. Methods: A search was conducted on the following databases: OVID Medline, Ovid EMBASE, EBSCO CINAHL, PROSPERO, and Cochrane Library. We included all the studies that reported on children with LM and docu- mented objective swallowing assessment using fberoptic endoscopic evaluation of swallowing (FEES) or vid- eofuoroscopic swallowing study (VFSS). Two authors independently screened all the studies, assessed the level of evidence in the included studies, and extracted data. Risk of bias assessment and pooled data analysis were performed. Results: The search yielded 512 abstracts. Four studies met the selection criteria representing 425 children. Three studies were retrospective uncontrolled case series and one was a prospective cohort study. In all studies but one, an instrumental assessment of swallowing was selectively performed in patients with clinical indicators of SwD. The pooled estimate (range) of prevalence of SwD was 49% (13.9–90.6%). Conclusion: The literature suggests a high prevalence of SwD in children with LM, however the level of evidence is low and generalizability is poor. The wide range of prevalence fgures suggests a signifcant variability in the threshold and indications to assess swallowing in children with LM. 1. Introduction Laryngomalacia (LM) has enjoyed a considerable attention in the pediatric otolaryngology literature as one of the commonly diagnosed pathologies of the upper airway in children. Among its different pre- sentations, the respiratory aspect has been reported the most [1]. This includes stridor, increased work of breathing, snoring, and apneas, among other presentations. Recently, more studies addressing the swallowing diffculties experienced by patients with LM as a primary outcome have been published; however, only a minority reported a systematic use of instrumental assessment [2]. The importance of employing objective testing becomes evident with the increased awareness of the faws of clinical, non-instrumental assessments per- formed by speech and language pathologists based on the high reported prevalence of silent aspiration in several published series (up to 89%) [3, 4]. Although no studies to date have been specifcally designed to study the degree and type of association between swallowing dysfunction (SwD) and LM, many have reported on the coexistence of the two con- ditions. Documenting prevalence fgures may provide insight into a possible association and can have implications on the goals of man- agement of LM. The aim of this study is to systematically review the literature for the prevalence of SwD in children diagnosed with LM. * Corresponding author. 2C3.57, Walter MacKenzie Health Sciences Centre, Edmonton, Alberta, Canada. E-mail addresses: drhusseinjaffal@gmail.com (H. Jaffal), aisaac@ualberta.ca (A. Isaac), connections@shaw.ca (W. Johannsen), scampbel@ualberta.ca (S. Campbell), hamdy.elhakim@albertahealthservices.ca (H.G. El-Hakim). Contents lists available at ScienceDirect International Journal of Pediatric Otorhinolaryngology journal homepage: www.elsevier.com/locate/ijporl https://doi.org/10.1016/j.ijporl.2020.110464 Received 14 September 2020; Accepted 16 October 2020