الفهرس 
IntroductionOnly 14 pages are availabe for public view
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Abstract
Laryngomalacia is the commonest cause of stridor in the pediatric population. There are varying degrees of disease severity mild, moderate and severe; although most cases are treated conservatively, severe cases which present with severe symptoms or associated comorbidities necessitate medical or surgical intervention. There are a lot of classifications for types of laryngomalacia described in the literature, among them Olney’s classification system which is widely used. It is based on the affected supraglottic structures on laryngoscope examination .GERD has been implicated as a causative factor in laryngomalacia because of a high association between the two, but the mechanism is unknown. It is plausible that the GERD- and LPR-induced edematous changes of the larynx are partially or fully responsible for the prolapse of the supra-arytenoid into the glottic inlet, as seen in variants of laryngomalacia. It was found that the proton pump inhibitor (PPI) esomeprazole reduces esophageal acidity and acidic reflux events in infants with GERD. Food and Drug Administration (FDA) has approved only one PPI for oral and intravenous use in infants <1 year of age (esomeprazole).This study was conducted in the Department of Otorhinolaryngology and head and neck surgery, Mansoura University Hospital, over one year (November 2021- November 2022). The study included 40 patients with moderate laryngomalacia. The patients were randomly allocated into two groups: group A (treatment group) (n=20), who received anti-reflux treatment (Esomeprazole), and group B (control group) (n=20), who did not receive treatment. Randomization was done by using the block randomization method. All cases in the treatment group received anti-GERD medications in the form of proton pump inhibitor (PPI) therapy (esomeprazole 1 mg/kg/day) once daily orally for three months. Follow up of the patients was scheduled once monthly in the OPC. Clinical and endoscopic assessment for the laryngomalacia symptoms and signs were performed. At the end of treatment, complete resolution was detected in 60 % of the treatment group and in 30 % in the control group. Moreover, 35 % of control group deteriorated and needed surgical intervention (supraglottoplasty), in contrast to only 10% in the treatment group who needed surgery. Consequently, there was statistically significant improvement in the treatment group compared to the control group. Patients in treatment group showed statistically significant improvement in terms of better weight gain, decreased stridor, choking. However, regarding the endoscopic score: there was no statistically significant difference between two groups. The overall success rate was better in the treatment group than the control group.