Laryngomalacia
Updates to Article Attributes
Laryngomalacia is the most common cause of noisy breathing in infants where it results in stridor. It is the result of a congenital abnormality of the cartilage in the larynx that that results in the dynamic partial supraglottic collapse of the larynx during breathing.
Clinical presentation
Most children present in early infancy with stridor. Symptoms are maximal around 6-8 months and the symptoms will have resolved in most by 12-24 months.
It may be associated with feeding difficulties in some patients and it is frequently seen in combination with gastro-oesophageal reflux disease.
Pathology
Laryngeal collapse occurs in the inspiratory phase of breathing wherewhen an anatomical abnormality results in intermittent upper airway obstruction and stridor.
The underlying anatomical abnormality is most commonly shortening of the aryepiglottic folds that result, resulting in side-to-side curling of the epiglottis. However, prolapse of supraglottic tissues into the laryngeal inlet during inspiration may also be the cause. The epiglottis, aryepiglottic folds and corniculate mounds of the arytenoids may be involved 1.
Some authors suggest that mucosal inflammation as the result of gastro-oesophageal reflux disease (GORD) may also be an aetiologicaetiological consideration 2. Where there is suspicion of GORD, it should be treated.
Radiographic features
The diagnostic investigation of choice is flexible laryngoscopy. Radiology is often not involved.
Patients may have chest radiographs because of associated chest findings, or upper-GI contrast studies to assess gastro-oesophageal reflux disease. They may also have chest cross-sectional imaging or ultrasound to make an assessment of the subglottic space and exclude a subglottic lesion.
Treatment and prognosis
Treatment is largely supportive since most children show spontaneous resolution after 12-24 months. Where there isWhen associated gastro-oesophageal reflux disease is present, that should be treated. Endoscopic supraglottoplasty may be required in severe cases where thisthere is significant airway obstruction.
Differential diagnosis
- congenital tracheal anomalies, e.g. tracheomalacia
- inhaled foreign body
- subglottic haemangioma
-<p><strong>Laryngomalacia</strong> is the most common cause of noisy breathing in infants where it results in stridor. It is the result of a congenital abnormality of the cartilage in the larynx that results in the dynamic partial supraglottic collapse of the larynx during breathing. </p><h4>Clinical presentation</h4><p>Most children present in early infancy with stridor. Symptoms are maximal around 6-8 months and the symptoms will have resolved in most by 12-24 months.</p><p>It may be associated with feeding difficulties in some patients and it is frequently seen in combination with gastro-oesophageal reflux disease.</p><h4>Pathology</h4><p>Laryngeal collapse occurs in the inspiratory phase of breathing where an anatomical abnormality results in intermittent upper airway obstruction and stridor. </p><p>The anatomical abnormality is most commonly shortening of the aryepiglottic folds that result in side-to-side curling of the epiglottis. However, prolapse of supraglottic tissues into the laryngeal inlet during inspiration may also be the cause. The epiglottis, aryepiglottic folds and corniculate mounds of the arytenoids may be involved <sup>1</sup>.</p><p>Some authors suggest that mucosal inflammation as the result of gastro-oesophageal reflux disease may also be an aetiologic consideration <sup>2</sup>. Where there is suspicion of GORD, it should be treated.</p><h4>Radiographic features</h4><p>The diagnostic investigation of choice is flexible laryngoscopy. Radiology is often not involved.</p><p>Patients may have chest radiographs because of associated chest findings, or upper-GI contrast studies to assess gastro-oesophageal reflux disease. They may also have chest cross-sectional imaging or ultrasound to make an assessment of the subglottic space and exclude a subglottic lesion.</p><h4>Treatment and prognosis</h4><p>Treatment is largely supportive since most children show spontaneous resolution after 12-24 months. Where there is associated gastro-oesophageal reflux disease, that should be treated. Endoscopic supraglottoplasty may be required in severe cases where this is significant airway obstruction.</p><h4>Differential diagnosis</h4><ul>- +<p><strong>Laryngomalacia</strong> is the most common cause of noisy breathing in infants where it results in stridor. It is the result of a congenital abnormality of the cartilage in the <a title="Larynx" href="/articles/larynx">larynx</a> that results in the dynamic partial supraglottic collapse of the larynx during breathing. </p><h4>Clinical presentation</h4><p>Most children present in early infancy with stridor. Symptoms are maximal around 6-8 months and the symptoms will have resolved in most by 12-24 months.</p><p>It may be associated with feeding difficulties in some patients and it is frequently seen in combination with <a title="Gastro-oesophageal reflux disease" href="/articles/gastro-oesophageal-reflux-disease">gastro-oesophageal reflux disease</a>.</p><h4>Pathology</h4><p>Laryngeal collapse occurs in the inspiratory phase of breathing when an anatomical abnormality results in intermittent upper airway obstruction and stridor.</p><p>The underlying anatomical abnormality is most commonly shortening of the aryepiglottic folds, resulting in side-to-side curling of the epiglottis. However, prolapse of supraglottic tissues into the laryngeal inlet during inspiration may also be the cause. The epiglottis, aryepiglottic folds and corniculate mounds of the arytenoids may be involved <sup>1</sup>.</p><p>Some authors suggest that mucosal inflammation as the result of gastro-oesophageal reflux disease (GORD) may also be an aetiological consideration <sup>2</sup>. Where there is suspicion of GORD, it should be treated.</p><h4>Radiographic features</h4><p>The diagnostic investigation of choice is flexible laryngoscopy. Radiology is often not involved.</p><p>Patients may have chest radiographs because of associated chest findings, or upper-GI contrast studies to assess gastro-oesophageal reflux disease. They may also have chest <a title="Cross-sectional imaging" href="/articles/cross-sectional-imaging-1">cross-sectional imaging</a> or ultrasound to make an assessment of the subglottic space and exclude a subglottic lesion.</p><h4>Treatment and prognosis</h4><p>Treatment is largely supportive since most children show spontaneous resolution after 12-24 months. When associated gastro-oesophageal reflux disease is present, that should be treated. Endoscopic supraglottoplasty may be required in severe cases where there is significant airway obstruction.</p><h4>Differential diagnosis</h4><ul>
-<li>subglottic haemangioma</li>- +<li><a title="subglottic haemangioma" href="/articles/subglottic-haemangioma">subglottic haemangioma</a></li>
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