Laryngomalacia is a congenital anomaly – meaning it is present at birth – of the larynx, or voice box, and is the most common cause of a particular kind of noisy breathing called stridor in infants. This occurs when the tissues of the voice box collapse inward when taking in a breath.
The noisy breathing associated with laryngomalacia is quite distinctive, and has a high-pitched, squeaky or fluttery quality. It may be noticeable constantly, or only some of the time, and is often worse with feeding, agitation, and when the baby lies on his or her back (rather than on their stomach).
While the exact cause of laryngomalacia is unknown, it is thought to be due to abnormal tone in the muscles of the larynx, potentially due to lower sensation than normal.
What are the symptoms?
While symptoms typically resolve by the age of 18-24 months, children with other health problems may have continued symptoms beyond infancy. Symptoms can be stratified into three categories.
Mild: occasional stridor, mild issues with feeding but proper weight gain
Moderate: constant stridor, slow weight gain, some gagging, coughing and/or vomiting with feeding
Severe: constant stridor, increased work of breathing, retractions, hypoxia, cyanotic episodes (when a child’s skin is tinged blue), weight loss or failure to thrive
How is laryngomalacia diagnosed?
The workup will begin with a thorough medical history. To follow, a flexible fiberoptic laryngoscopy will be performed safely at your otolaryngologist’s (ENT’s) office. This procedure consists of the insertion of a small and flexible camera gently into your infant’s nose to evaluate their voice box. This allows for direct visualization and diagnosis.
How is laryngomalacia managed?
Most of the time, infants with laryngomalacia have relatively mild symptoms that can be managed with close observation, and sometimes reflux medication.
Associated conditions, such as gastroesophageal reflux (GERD), should be treated as this may be linked to symptom improvement. For cases where apnea, airway distress, or failure to thrive occurs, a supraglottoplasty is recommended.
What is a supraglottoplasty?
In some children, breathing and feeding symptoms are severe enough that they need a surgery called supraglottplasty to relieve the obstruction in the larynx.
This is a procedure performed in the operating room under general anesthesia. It is done endoscopically, through the mouth, and involves the release of any tethered tissue (aryepiglottic folds) and trimming of the redundant tissue that may be flopping into the airway (arytenoids). Results of this surgery are excellent and complications are rare.
To note, supraglottoplasty is less effective in patients with neurologic conditions or syndromes.
Your child will stay in the hospital overnight following the procedure. Pain is minimal and can be treated with Tylenol. Additional medications, like steroids, will be given to decrease inflammation.