Laryngomalacia

Overview 
Theory 
Diagnosis 
Management 
Follow up 
Resources 

Last reviewed: 17 May 2025

Last updated: 13 Dec 2022

Laryngomalacia is a congenital abnormality of the larynx cartilage that predisposes to dynamic supraglottic collapse during the inspiratory phase of respiration, resulting in intermittent upper airway obstruction and stridor.

Most common laryngeal anomaly and most frequent congenital cause of stridor in infants.

Natural history is presentation in early infancy with maximal symptoms at 6 to 8 months before gradual improvement and spontaneous resolution within 12 to 24 months.

Presents with inspiratory stridor. Some patients have upper airway obstruction with associated feeding difficulties. Frequently associated with GERD.

Diagnosis is made by the clinical features and with flexible laryngeal endoscopy. Direct rigid laryngoscopy under anesthesia may also be required. Possibility of additional airway lesions should be considered.

Treatment depends on disease severity; observation alone (with treatment of any associated GERD) is appropriate for most cases. Endoscopic supraglottoplasty may be required for more severe disease. Tracheostomy and pressure-assisted ventilation are other possible therapies.

Definition

Laryngomalacia (LM) is a congenital abnormality that predisposes to dynamic supraglottic collapse during the inspiratory phase of respiration, resulting in intermittent upper airway obstruction and stridor. LM is the most common source of stridor in infants and the most common congenital laryngeal anomaly.[1][2][3]

History and exam

Key diagnostic factors

stridor
onset within 2 weeks of birth
features of airway obstruction
resolution of symptoms by 2 years of age
normal cry

Full details

Other diagnostic factors

feeding difficulties
weight loss or failure to thrive
hypotonia
dysmorphic features

Full details

Risk factors

GERD
neurologic abnormalities
laryngeal anatomic abnormalities
male sex
genetic syndromic disorder

Full details

Diagnostic tests

1st tests to order

flexible laryngoscopy

Full details

Tests to consider

rigid laryngobronchoscopy
FEES testing
polysomnography
chest x-ray
lateral neck radiograph
ECG
echocardiogram

Full details

Treatment algorithm

ONGOING

mild disease

moderate disease

severe disease

Contributors

Authors

Simone J. Boardman, MBBS, FRACS (OHNS)

Consultant Paediatric Otolaryngologist

The Children's Hospital at Westmead

Sydney

Australia

Disclosures

SJB declares that she has no competing interests.

Acknowledgements

Dr Simone Boardman would like to gratefully acknowledge Mr C. Martin Bailey, a previous contributor to this topic.

Disclosures

CMB is an author of a number of references cited in this topic.

Peer reviewers

Kevin Pereira, MD

Director

Pediatric Otolaryngology-HNS

University of Maryland School of Medicine

Baltimore

Disclosures

KP declares that he has no competing interests.

Haytham Kubba, FRCS

Consultant Paediatric Otolaryngologist

Royal Hospital for Sick Children (Yorkhill)

Glasgow

Disclosures

HK declares that he has no competing interests.

Gresham Richter, MD

Assistant Professor

Associate Residency Program Director

Otolaryngology - Head and Neck Surgery

University of Arkansas for Medical Sciences

Little Rock

Disclosures

GR declares that he has no competing interests.

References

Our in-house evidence and editorial teams collaborate with international expert contributors and peer reviewers to ensure that we provide access to the most clinically relevant information possible.

Key articles

Olney DR, Greinwald JH Jr, Smith RJ, et al. Laryngomalacia and its treatment. Laryngoscope. 1999 Nov;109(11):1770-5. Abstract

Carter J, Rahbar R, Brigger M, et al. International Pediatric ORL Group (IPOG) laryngomalacia consensus recommendations. Int J Pediatr Otorhinolaryngol. 2016 Jul;86:256-61. Abstract

McCaffer C, Blackmore K, Flood LM. Laryngomalacia: is there an evidence base for management? J Laryngol Otol. 2017 Nov;131(11):946-54. Abstract

Yellon RF, Goldberg H. Update on gastroesophageal reflux disease in pediatric airway disorders. Am J Med. 2001 Dec 3;111(suppl 8A):78S-84S. Abstract

Reference articles

A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.

Differentials
- Vocal cord palsy
- Subglottic stenosis
- Laryngeal web
More Differentials
Guidelines
- Laryngomalacia consensus recommendations
- New Zealand guidelines for the assessment of sleep-disordered breathing in childhood
More Guidelines
Patient information
Reflux in infants
More Patient information
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Laryngomalacia

Summary

Definition

History and exam

Key diagnostic factors

Other diagnostic factors

Risk factors

Diagnostic tests

1st tests to order

Tests to consider

Treatment algorithm

mild disease

moderate disease

severe disease

Contributors

Authors

Simone J. Boardman, MBBS, FRACS (OHNS)

Disclosures

Acknowledgements

Disclosures

Peer reviewers

Kevin Pereira, MD

Disclosures

Haytham Kubba, FRCS

Disclosures

Gresham Richter, MD

Disclosures

References

Key articles

Reference articles

A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.

Differentials

Guidelines

Patient information

Log in or subscribe to access all of BMJ Best Practice

Log in or subscribe to access all of BMJ Best Practice

Log in to access all of BMJ Best Practice