Laryngomalacia

Abstract

Laryngomalacia is the most common cause of stridor in infants. Stridor results from upper airway obstruction caused by collapse of supraglottic tissue into the airway. Most cases of laryngomalacia are mild and self-resolve, but severe symptoms require investigation and intervention. There is a strong association with gastroesophageal reflux disease in patients with laryngomalacia, and thus medical treatment with antireflux medications may be indicated. Supraglottoplasty is the preferred surgical treatment of laryngomalacia, reserved only for severe cases. Proper identification of those patients who require medical and surgical intervention is key to providing treatment with successful outcomes.

Clinical relevance of quality of life in laryngomalacia

“…Laryngomalacia‐associated stridor is often described as high pitched and frequently occurs during the inspiratory phase of respiration, during which the lack of neuromuscular or structural support allows the supraglottic structures to prolapse . The majority of laryngomalacia cases are self‐limited and resolve spontaneously by the age of 12 to 24 months, but an estimated 10% to 30% are severe enough to require surgical intervention …”

“…1,2 The majority of laryngomalacia cases are self-limited and resolve spontaneously by the age of 12 to 24 months, but an estimated 10% to 30% are severe enough to require surgical intervention. [1][2][3][4] Disease severity is generally classified as mild, moderate, or severe based on associated feeding and obstructive symptoms. 2 Mild disease is described as inconsequential intermittent stridor and sporadic feeding difficulties, and moderate disease presents with dyspnea and consistent feeding difficulties.…”

Laryngeal ultrasound for the diagnosis of laryngomalacia in infants

“…Laryngomalacia tends to progress during early life and usually resolves spontaneously by the time the child is 12‐18 months old . In most cases, laryngomalacia presents as mild‐to‐moderate stridor that manifests mainly during agitation and feeding, however, in some moderate and in severe cases it may cause respiratory difficulties and distress, feeding problems including choking, failure to thrive and up to 10% require surgical intervention …”

Endoscopic surgical management of inspiratory stridor in newborns and infants

“…Unless there are severe symptoms, such as failure to thrive or dysphagia, most patients do well with expectant management, with only approximately less than 15% requiring surgical intervention [1]. Those with severe symptoms are usually treated with supraglottoplasty, which has a high success rate [2]. However, there are several other airway pathologies that can be encountered causing symptoms that may mimic laryngomalacia, such as vallecular cysts or anterior glottic webs and should be carefully considered when evaluating these newborns and infants.…”