Lung

Laryngomalacia

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Laryngomalacia, Larynx Chondromalacia

  • Epidemiology
  1. Most common cause of chronic Stridor in infants
  2. Onset within first month of life and continues until 18-24 months of age
  • Pathophysiology
  1. Congenital disorder in infants resulting in Noisy Breathing
  2. Weak Larynx that collapses with inspiration, leading to partial airway obstruction and Stridor
  • Signs
  1. Inspiratory Stridor
  2. Provocative factors (Increases Stridor)
    1. Crying or other Agitation
    2. Exertion
    3. Feeding
    4. Upper Respiratory Infection
  3. Palliative factors (Decreases Stridor)
    1. Prone position
    2. Neck extension
  4. Severe obstructive signs (rare)
    1. Failure to Thrive
    2. Apnea
    3. Cyanosis
    4. Pulmonary Hypertension
  • Associated Conditions
  1. Poor feeding and poor weight gain (88% of cases)
    1. Suck-swallow-breath sequence is poorly coordinated in moderate to severe Laryngomalacia
  • Diagnosis
  1. Typically diagnosed on clinical features alone
  2. Bronchoscopy
    1. Indicated in severe cases
  • Course
  1. Onset of symptoms in first month of life
    1. Severe cases present in the first 2 weeks of life
  2. Self limited (resolves spontaneously by 18-24 months in most cases)
  3. Rarely progresses to severe obstruction
  • Management
  1. Reassurance
  2. Control Pediatric Gastroesophageal Reflux Disease
  3. Surgery (Epiglottoplasty or Supraglottoplasty)
    1. Indications in Severe Obstruction (rarely indicated)
      1. Significant Respiratory Distress
      2. Apnea
      3. Failure to Thrive
    2. Supraglottoplasty
      1. Effective in 80% of cases in improving Swallowing and decreasing aspiration risk
  • References
  1. Dahan, Campbell and Melville (2020) Crit Dec Emerg Med 34(11): 3-10
  2. Nussbaum (1990) Chest 98:942-4 [PubMed]