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.
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.
History and exam
Key diagnostic factors
- onset within 2 weeks of birth
- features of airway obstruction
- resolution of symptoms by 2 years of age
- normal cry
Other diagnostic factors
- feeding difficulties
- weight loss or failure to thrive
- dysmorphic features
- neurologic abnormalities
- laryngeal anatomic abnormalities
- male sex
- genetic syndromic disorder
1st investigations to order
- flexible laryngoscopy
Investigations to consider
- rigid laryngobronchoscopy
- FEES testing
- chest x-ray
- lateral neck radiograph
- Vocal cord palsy
- Subglottic stenosis
- Laryngeal web
- Laryngomalacia consensus recommendations
- New Zealand guidelines for the assessment of sleep-disordered breathing in childhood
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