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Preciado and Zalzal. Statistical analysis: Preciado. Ad ministrative, technical, andmaterial support: Preciado. Study supervision: Zalzal. Financial Disclosure: None reported. Previous Presentation: This study was presented in part at the European Society of Pediatric OtolaryngologyMeet ing; May 19-21, 2012; Amsterdam, the Netherlands.

and, for our analysis, we had to accept as objective the definition of each individual study. Also, the definitions of surgical failure varied from report to report and were not uniform. In 4 reports, surgical failure was explicitly stated and measured, 4,10,11,13 while in 2 reports, this was inferred from the reported outcomes. 3,14 To be as objec tive as possible, we used the number of events of revi sion surgery, tracheotomy tube placement, or gastros tomy tube placement in all instances to determine surgical failure. Finally, the follow-up rate for most of the stud ies was not reported. In conclusion, after analyzing the medical literature on supraglottoplasty outcomes in aggregate, we can re port that the results of this procedure are excellent over all and that severe complications, such as supraglottic ste nosis and aspiration, are uncommon. The relative risk of revision surgery, tracheotomy tube placement, or gas trostomy is significantly higher among patients with as sociatedmedical comorbidities. This increased risk should be taken into account when counseling parents as to the expected surgical outcome of infants undergoing supra glottoplasty. Randomized, prospective studies with well defined protocols appear to be necessary to further stratify the risk of failure by the specific medical comorbidity and/or surgical technique used. Submitted for Publication: April 8, 2012; final revision received May 3, 2012; accepted May 17, 2012. Publ ished Onl ine: July 16, 2012. doi :10.1001 /archoto.2012.1251 Correspondence: Diego Preciado, MD, PhD, Division of Otolaryngology, Children’s National Medical Center, 111 Michigan Ave NW, Washington, DC 20010 (dpreciad @cnmc.org). Author Contributions: Dr Preciado had full access to all the data in the study and takes responsibility for the in tegrity of the data and the accuracy of the data analysis. Study concept and design: Preciado. Acquisition of data: Pre ciado. Analysis and interpretation of data: Preciado and Zalzal. Drafting of the manuscript: Preciado. Critical re vision of the manuscript for important intellectual content:

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