Laryngomalacia occurs where the supraglottic larynx (the part of the larynx above the vocal cords) is structured in a way that causes partial airway obstruction. It causes chronic stridor during inspiration when the larynx flops across the airway as the infant breathes in. Stridor is a harsh whistling sound.
Laryngomalacia occurs in infants, with symptoms peaking at around 6 months of age.
Structural Changes
There are two aryepiglottic folds at the entrance of the larynx. They run between the epiglottis and the arytenoid cartilages on either side of the airway. Their role is to prevent food or fluids from entering the larynx and trachea. In laryngomalacia, the aryepiglottic folds are shortened, which pulls on the epiglottis and changes its shape to a characteristic “omega” shape.
In laryngomalacia, the tissue surrounding the supraglottic larynx is softer and has less tone, allowing it to flop across the airway. During inspiration, the air moving through the larynx to the lungs pulls the floppy tissue across the airway to partially occlude it. This partial airway obstruction generates the whistling sound (stridor).
Presentation
Laryngomalacia presents with intermittent inspiratory stridor, which is more prominent when feeding, upset, lying on the back, or during upper respiratory tract infections. It is not associated with respiratory distress.
It can cause difficulties with feeding, but rarely causes complete airway obstruction or other complications.
Disease Course and Management
Laryngomalacia resolves as the larynx matures and grows and can better support itself, preventing it from flopping over the airway. Usually, no interventions are required, and the child is monitored as they grow out of the condition.
Rarely tracheostomy may be necessary. This involves inserting a tube through the front of the neck into the trachea, bypassing the larynx. Surgery is also an option to alter the tissue in the larynx and improve the symptoms.
Last updated February 2025
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