Laryngomalacia

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 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.

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[1]Loke D, Ghosh S, Panarese A, et al. Endoscopic division of the ary-epiglottic folds in severe laryngomalacia. Int J Pediatr Otorhinolaryngol. 2001 Jul 30;60(1):59-63. http://www.ncbi.nlm.nih.gov/pubmed/11434955?tool=bestpractice.com and the commonest congenital laryngeal anomaly.[2]Holinger LD. Etiology of stridor in the neonate, infant and child. Ann Otol Rhinol Laryngol. 1980 Sep-Oct;89(5 Pt 1):397-400. http://www.ncbi.nlm.nih.gov/pubmed/7436240?tool=bestpractice.com [3]Werner JA, Lippert BM, Dunne AA, et al. Epiglottopexy for the treatment of severe laryngomalacia. Eur Arch Otorhinolaryngol. 2002 Oct;259(9):459-64. http://www.ncbi.nlm.nih.gov/pubmed/12386747?tool=bestpractice.com