What is laryngomalacia?

Laryngomalacia is a congenital softening of the tissues of the larynx (voice

box) above the vocal cords. This is the most common cause of noisy breathing
in infancy. The laryngeal structure is malformed and floppy, causing the
tissues to fall over the airway opening and partially block it.
For most infants, laryngomalacia is not a serious condition they have noisy
breathing, but are able to eat and grow. For these infants, laryngomalacia will
resolve without surgery by the time they are 18 to 20 months old. However, a
small percentage of babies with laryngomalacia do struggle with breathing,
eating and gaining weight. These symptoms require prompt attention.

When to seek help

Go to the hospital immediately if your baby:

Stops breathing for more than 10 seconds

Turns blue around the lips while breathing noisily

Pulls in the neck or chest without relief after being repositioned or

awakened

Causes
Laryngomalacia as seen in a childs airway during microlaryngoscopy.
The exact cause of laryngomalacia is not known. Relaxation or a lack of
muscle tone in the upper airway may be a factor. The malformation is usually
present at birth or appears within the first month of life. Gastroesophageal

reflux (GE reflux) may contribute to the severity of the symptoms. The noisy
breathing is often worse when the infant is on his back or when crying.

Signs and symptoms

If your child is born with laryngomalacia, symptoms may be present at birth,

and can become more obvious within the first few weeks of life. It is not
uncommon for the noisy breathing to get worse before it improves, usually
around 4 to 8 months of age. Most children outgrow laryngomalacia by 18 to
20 months of age. Symptoms include:

Noisy breathing (stridor) An audible wheeze when your baby

inhales (breathes in). It is often worse when the baby is agitated, feeding,
crying or sleeping on his back.

High pitched sound

Difficulty feeding

Poor weight gain

Choking while feeding

Apnea (breathing stoppage)

Pulling in neck and chest with each breath

Cyanosis (turning blue)

Gastroesophageal reflux (spitting, vomiting and regurgitation)

Aspiration (inhalation of food into the lungs)

Testing and diagnosis

Laryngomalacia seen during an examYour

doctor will ask you some questions about your babys health problems and
may recommend a test called a nasopharyngolaryngoscopy (NPL) to further
evaluate your babys condition.
During this test, done in your doctors office, a tiny camera that looks like a
strand of spaghetti with a light on the end is passed through your babys nostril
and into the lower part of the throat where the larynx is. This allows your
doctor to see your babys voice box.
If laryngomalacia is diagnosed, the doctor may want to do other diagnostic
tests to evaluate the extent of your childs problems and to see whether the
lower airway is affected. These tests may include:

X-ray of the neck

Airway fluoroscopy

Microlaryngoscopy and bronchoscopy (MLB)

Esophagogastroduodenoscopy (EGD) and pH probe

Functional endoscopic evaluation of the swallow (FEES)

Treatment
In 90 percent of cases, laryngomalacia resolves without treatment by the time
your child is 18 to 20 months old. However, if the laryngomalacia is severe,
your childs treatment may include medication or surgery.

Medication
Your childs doctor may prescribe an anti-reflux medication to help manage the
gastroesophageal reflux (GERD). This is important because your childs
chronic neck and chest retractions from the laryngomalacia can worsen reflux.
Also, the acid reflux can cause swelling above the vocal cords and worsen the
noisy breathing.

Surgery
A surgery called supraglottoplasty is the treatment of choice if your child's
condition is severe. Symptoms that signal the need for surgery include:

Life-threatening apneas (stoppages of breathing)

Significant blue spells

Failure to gain weight with feeding

Significant chest and neck retractions

Need for extra oxygen to breathe

Heart or lung issues related to your child's inability to get enough

oxygen

This surgery may not completely eliminate the noisy breathing but it should
help to:

Reduce the severity of the symptoms

Lessen the apneas (breathing stoppages)

Reduce the extra oxygen requirements

Improve swallowing

Help your child gain weight

The safety of your child's swallow should be reevaluated after the surgical
procedure.

Center for Pediatric Airway Disorders

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