Title

Laryngomalacia: More than just noisy breathing: A qualitative case study

Author Identifiers

ORCID: 0000-0002-5332-5840

Date of Award

2019

Degree Type

Thesis

Degree Name

Master of Nursing (Research)

School

School of Nursing and Midwifery

First Advisor

Dr Deborah Sundin

Second Advisor

Dr Gideon de Jong

Third Advisor

Dr Jennifer Sharp

Field of Research Code

11, 1114, 111403

Abstract

Background: Laryngomalacia features prolapsing tissue partially obstructing the larynx and airway. It seems an under-recognised condition in which the characteristic inspiratory stridor is often dismissed as “just a noise that babies make.” Most literature suggests laryngomalacia is a self-limiting disease that generally resolves by two years of age. The implication that laryngomalacia is mostly an inconsequential disease, a view sometimes held by healthcare professionals, is inconsistent with its associated morbidities and complexities. The impact of laryngomalacia on the affected baby or child and the family can be significant and ongoing.

Research problem: Laryngomalacia appears to be under-recognised yet the implications of the disease for the immediate and long-term well-being of affected babies and children are significant.

Aim: This research sought to explore and better understand the complexities of laryngomalacia. This in-depth enquiry has delved into the presenting complexities of laryngomalacia, openly questioning their interconnectedness of symptomology, whilst also considering the short and long- term implications of laryngomalacia.

Research design: A single family was studied, in which all children experienced varying degrees of laryngomalacia and comorbidly associated gastro-oesophageal reflux. A naturalistic case study and responsive evaluation approach was employed. Interview participants were able to engage freely. The conceptual framework of this enquiry considered sensory integration and integration of the body as a whole, thereby guiding a more holistic exploration of laryngomalacia within a real-life context.

Methods: Emergent data from semi-structured interviews facilitated an open exploration of laryngomalacia as it related to each child. Findings for each case were compared and contrasted. Further interviews were conducted with three skilled senior health professionals—an otolaryngologist, a speech therapist and an occupational therapist— who were conversant with laryngomalacia and familiar with the studied children. Rich, thick descriptions were derived from the diverse data set of interviews, reflections post interview, memos, medical notes and a group member check.

Findings and intermediate conclusions: Five intermediate conclusions were drawn from themes that emerged from the data: increased work of breathing with associated feeding difficulties and swallow dysfunction, which was seen to be long standing in nature; hypotonia, hypermobility and postural instability; feeding aversion and sensory dysregulation; lack of clinical knowledge with poor understanding of laryngomalacia; and other presenting morbidities including sleep disordered breathing, apnoeas, gastro-oesophageal reflux, croup, chest infections, pneumonias, aspiration pneumonia, hypotonia and overwhelmed behaviours associated with feeding aversion and tactile defensiveness. Sensory dysregulation issues appeared to be further exacerbated by feeding aversion and the threat to breath experienced by the children. The burden of care experienced by the family was considerable. These intermediate conclusions were presented, discussed, and accepted by the study participants during a group member check meeting.

Discussion and conclusion: This study provided insights into the real-life complexities of laryngomalacia including swallow dysfunction with other morbidities negatively affecting the studied children. The burden of care experienced by the family was considerable as the parents navigated the healthcare system. There is a need for a holistic and open exploration to illuminate the condition of laryngomalacia in a meaningful way.

Access Note

Access to this thesis is embargoed until 14 December 2024.

Access to this thesis is restricted. Please see the Access Note below for access details.

Share

 
COinS