Fiberoptic Endoscopic Examination of Swallowing in Laryngomalacia Patients

Background and Objectives Laryngomalacia is the most common cause of stridor in infants and patients frequently present with feeding and respiratory complications. Fiberoptic Endoscopic Evaluation of Swallowing (FEES) is essential for diagnosing swallowing dysfunction in this population. This study describes the FEES findings and clinical characteristics of pediatric laryngomalacia patients in a tertiary referral setting.Subjects and Method This retrospective study included descriptive analyses of 21 laryngomalacia patients who underwent FEES between January 2021 and December 2024. Clinical variables included laryngomalacia type and severity, comorbidities, symptoms, and FEES outcomes. Food consistencies tested were adjusted by age and swallowing ability.Results Most patients were male (71.5%) with type I (80.9%) and severe-grade laryngomalacia (71.4%). Comorbidities were present in 76.2%, and swallowing symptoms in 95.2%. FEES identified 14 swallowing abnormalities across consistencies, with penetration (42.8%) and residue (28.5%) being most common. Thick liquids (milk) accounted for the majority of abnormalities. Patients with tracheostomy or severe laryngomalacia demonstrated a higher frequency of dysfunction. Silent aspiration was observed in 14.2% of patients.Conclusion Swallowing dysfunction is prevalent in infants with laryngomalacia, particularly in those with comorbidities and severe anatomical involvement. FEES is a valuable tool for early identification of penetration, aspiration risk, and silent dysphagia, enabling targeted management in high-risk populations.