Laryngomalacia

[Badri]

Posted by Dr. Dharmabalan in the IMA CGP Journal:

Laryngomalacia, (soft larynx) is a congenital abnormality of the laryngeal cartilage. It is a dynamic lesion resulting in collapse of the supraglottic structures during inspiration, leading to airway obstruction. It is thought to represent a delay of maturation of the supporting structures of the larynx. Laryngomalacia is the most common cause of congenital stridor and is the most common congenital lesion of the larynx.

Laryngomalacia may affect the epiglottis, the arytenoid cartilages, or both. When the epiglottis is involved, it is often elongated, and the walls fold in on themselves to form an omega-shaped epiglottis.

Laryngomalacia is the most common cause of chronic inspiratory noise in infants, no matter which type of noise is heard. Infants with laryngomalacia have a higher incidence of gastroesophageal reflux and children with significant reflux may have pathologic changes similar to laryngomalacia.

Although this is a congenital lesion, airway sounds typically begin at age 4-6 weeks. Symptoms typically peak at age 6-8 months and remit by age 2 years.
Noises are inspiratory and may sound like nasal congestion, with which they are initially confused. However, the noises persist and no nasal secretions are present. The noise may be more high pitched, crowing stridor.
Noise is often increased when the baby is supine, during crying or agitation, during upper respiratory infection episodes.
The baby's cry is usually normal. Usually, no feeding intolerance is noted.
The infant is usually happy and thriving.

In more than 90% of cases, the only treatment necessary for laryngomalacia is time. The lesion gradually improves, and noises disappear by age 2 years in virtually all infants.

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