1296 Surgical Management of OSA in a Patient with Laryngomalacia and Tonsillar Hypertrophy

Abstract Introduction Laryngomalacia is a dynamic airway obstruction which causes collapse of supraglottic structures into the airway during inspiration causing stridor and can lead to upper airway obstruction and obstructive sleep apnea. Report of case(s) Patient is a 4-year-old with history of GDD, Cerebral palsy and Sleep apnea. He has issues with usage of CPAP and surgical options were considered for management of OSA due to multifactorial causes. PSG initially done in 2021 showed AHI 8.2/hr of sleep. Patient underwent evaluation, supraglottoplasty for tracheobronchomalacia, adenoidectomy in 2022 and underwent bilateral tonsillectomy in April 2024. Repeat PSG in Aug 2024 showing AHI 8.2, O2 nadir 93%. supraglottoplasty, adenoidectomy, PE tube replacement on in 2022. Patient was seen in clinic on 09/18/24 and Auto CPAP prescription was sent and was pending evaluation by ENT considering surgical history. The patient then underwent DISE on March 2025 which showed Laryngomalacia and was scheduled for supraglottoplasty in May 2025. After the supraglottoplasty, the patient was reevaluated in sleep clinic and showed significant improvement per the mother and his snoring also improved. His sleep study following the surgery showed an AHI of 6.4/hr. of sleep and minimum oxygen saturation of 90%. Conclusion Laryngomalacia may cause OSA due to dynamic obstruction of the airway and patients benefit surgical correction. Support (if any)