Pediatric Airway Disorders

Laryngomalacia

What is laryngomalacia?

Laryngolmalacia Small Image
Laryngomalacia seen during exam
Enlarge+Laryngomalacia is a softening of the tissues of the larynx (voice box) above the vocal cords. This softening causes the tissues to become floppy, and they may fall over the airway opening and partially block it. It is a common condition in infants.

What causes laryngomalacia?

The exact cause of laryngomalacia is not known but relaxation or a lack of muscle tone in the upper airway may be a factor. It is often worse when the infant is on his or her back, because the floppy tissues can fall over the airway opening more easily in this position.

When does laryngomalacia occur?

Laryngomalacia symptoms are usually 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.

Signs of laryngomalacia

Is laryngomalacia a serious condition?

For most infants, laryngomalacia is not a serious condition -- they do not have serious breathing problems and are able to eat and grow. For these infants, laryngomalacia will resolve without surgery by the time they are 18 to 20 months of age. However, a small percentage of babies with laryngomalacia have symptoms that need prompt attention.

When should I seek help?

Go to the hospital immediately if your baby:

Call your doctor if your baby:

How does the doctor diagnose laryngomalacia?

Your doctor will ask you some questions about your baby’s health problems and may recommend a test called a flexible laryngoscopy (lar ring os co pee) to further evaluate your baby’s condition.

During this test, done in your doctor’s office, a tiny camera that looks like a strand of spaghetti with a light on the end is passed through your baby’s nostril and into the lower part of the throat where the larynx is. This allows your doctor to see your baby’s voicebox.

After the diagnosis -- additional tests

If laryngomalacia is diagnosed, the doctor may want to do other diagnostic tests to evaluate the extent of your child’s problems and to see whether the lower airway is affected. These tests may include:

X-ray of the neck

A neck X-ray is done to make sure that your baby does not have other problems below the voice box (in the subglottis, trachea or chest). These are areas that the doctor cannot see during the flexible laryngoscopy.

Airway fluoroscopy

The doctor may also order a motion picture X-ray of the trachea to make sure that there are no other problems.

Microlaryngoscopy (my crow lar ring os co pee)and bronchoscopy (brawn cos co pee), also known as MLB

This test is done when a neck X-ray shows additional problems in the lower airway. Your child is taken to the operating room and given anesthesia. Then the doctor passes a tiny camera through your child’s mouth and down past the vocal cords (larynx) to look at the area below the vocal folds that may be contributing to the stridor (noisy breathing). The surgeon will take some pictures and will review the results with you afterward.

EGD or esophagogastroduodenoscopy pH probe

This test will be done if your child's doctor suspects that there may be a more severe problem.

Laryngomalacia treatment

In almost all cases (99 percent), laryngomalacia resolves without treatment by the time your child is 18 to 20 months of age. However, if the laryngomalacia is severe, your child’s treatment may include medication or surgery.

Medication

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

 

Surgery

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

Supraglottoplasty

In this surgery, extra tissue above the vocal cords is trimmed in the operating room. Your child will be under general anesthesia while the surgeon does a thorough evaluation of the airway and removes the tissue. After surgery, your child will be taken to the pediatric intensive care unit (PICU) and will spend one night with a breathing tube in the nose. If there is not much swelling in this area, and if the surgeon feels it will be safe, the breathing tube will be removed the next day in the PICU. Your child will then be observed for another day to ensure that the airway is safe, and that your child is getting enough oxygen and is drinking normally.

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

Contact us

For more information about the conditions we treat or for help with airway problems, please contact us at 215-590-3440 and ask for the Airway Center coordinator.

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