Predictors of Surgical Intervention and Clinical Outcomes in Infantile Laryngomalacia: A Five-Year Tertiary Care Study from Eastern India

Objective: To evaluate clinical profile, associated comorbidities, and predictors of surgical intervention in children with infantile laryngomalacia (LM) at a tertiary care centre in Eastern India. Methods: This retrospective cohort study included children aged 0–5 years diagnosed with LM between January 2019 and December 2024. Clinical features, comorbidities including gastro-oesophageal reflux disease (GERD) and synchronous airway lesions (SALs), management, and outcomes were analysed. Factors associated with surgical intervention were evaluated using univariate analysis. Results: Sixty-eight children were included (male:female 1.9:1). Median age at symptom onset was 2.5 months and at diagnosis 5 months. Inspiratory stridor was universal, while feeding difficulty (47%), aspiration (18%), and failure-to-thrive (22%) were common. GERD was present in 31% and SALs in 26%. Conservative management was successful in 82.4%, while 17.6% required supraglottoplasty. At 12 months, 82% showed complete resolution of stridor. Presence of SALs (OR 4.1; p = 0.018), feeding difficulty (OR 3.9; p = 0.022), and GERD (OR 2.8; p = 0.041) were significantly associated with surgical intervention. Conclusions: Infantile laryngomalacia commonly presents with stridor and feeding difficulties, with most children improving on conservative management. However, the presence of synchronous airway lesions and feeding dysfunction significantly increases the likelihood of surgical intervention. Early comprehensive airway evaluation may aid risk stratification and optimise management.