Laryngomalacia

Question 1

What is laryngomalacia?

Answer 1

Conditon affecting infants where the supraglottic larynx has weirdly structured

causing partial airway obstruction

Congenital abnormality of the larynx

aryepiglottic folds being short, pulling on the epiglottis and changing into ‘omega’ shape

Question 2

What is the clinical presentation of laryngomalacia?

Answer 2

peak incidence at 6 months

Inspiratory stridor : harsh whistling sound when breathing in

What makes it worse? : on feeding, lying on back or during URTIs

Question 3

What makes laryngomalacia worse?

Answer 3

• Inspiratory Stridor → harsh whistling sound when breathing in.
  
  • Intermittent. Worse when feeding, upset, lying on back or during URTIs.

Question 4

laryngomalacia is the commonest cause of noisy breathing, what other differentials are there?

Answer 4

croup
acute epiglottis
inhaled foreign body

Question 5

What will mild disease look like and how to manage it?

Answer 5

As there is no resp distress or failure to thrive

• Observation and reassurance
• feed infants upright
• GORD therapy e.g. thick feeds

Question 6

What will moderate disease look like and how to manage it?

Answer 6

Moderate : may have increased work of breathing and weight loss

• GORD therapy
• Surgical therapy : endoscopic supraglottoplasy or tracheostomy
• May need BiPAP

Question 7

How to manage severe disease?

Answer 7

Surgical therapy (endoscopic supraglottoplasty)

• BiPAP + GORD therapy

Question 8

Prognosis of laryngomalacia?

Answer 8

Self resolves before 2 years of age usually