Respiratory: Laryngomalacia & Inhaled Foreign Body Flashcards
What is the most common congenital ariway disorder?
Laryngomalacia
What is the most common cause of stridor in neonates?
Laryngomalacia
What is laryngomalacia?
Characterised by flaccidity of the supraglotic structures.
The larynx is soft and floppy as a result and collapses during breathing.
When does laryngomalacia typically present?
Within the first few weeks of life.
Typically resolves within the first two years, although in rare cases it can extend later into childhood.
Why do symptoms in laryngomalacia typically peak at 6-8 months?
This is when respiratory function increases before the larynx (and hence diameter for airflow) increases in size.
What causes inspiratory stridor in laryngomalacia?
Immature laryngeal cartilages collapse over the inlet to the larynx causing inspiratory stridor.
In particular these cartilages are:
- A long, curled, ‘omega-shaped’ epiglottis
- Tall, bulky aryepiglottic folds
Clinical features of laryngomalacia?
1) Inspiratory stridor: worse on lying flat or exertion
2) Respiratory distress, failure to thrive and cyanosis are rare
3) Symptoms often mild with stridor being intermittent and not accompanied with other symptoms and no impact on growth.
What are some signs of more severe causes of laryngomalacia?
- Respiratory distress
- Dyspnoea with intercostal / sternal recession
- Feeding difficulties or episodes of suffocation/cyanosis whilst feeding
- Poor weight gain
- Obstructive sleep apnoea
Give 5 differentials for laryngomalacia
1) Vocal Cord Paralysis
2) Subglottic stenosis
3) Tracheomalacia
4) Croup
5) Supraglottitis / Epiglottitis
Cause of bilateral vs unilateral vocal cord paralysis?
Bilateral –> most commonly congenital
Unilateral –> most common following surgery, causing recurrent laryngeal nerve injury
What is the key investigation for confirming laryngomalacia?
Flexible endoscopy (laryngoscopy) via the nose or mouth to view the larynx and laryngeal cartilages.
Management of mild cases of laryngomalacia?
Most (~90%) of cases are mild and do not require treatment.
Parents should be reassured that the condition will resolve by 12-16 months but symptoms may peak at 6 months and may be exacerbated following RTIs.
Prognosis of laryngomalacia?
Prognosis is generally good and 99% will self-resolve with time.
What are the 4 most common congenital airway abnormalities?
1) laryngomalacia
2) bilateral vocal cord paralysis
3) subglottic stenosis
4) laryngeal webs
Give 3 differentials for a stridor in children
1) Croup
2) Epiglottitis
3) Laryngomalacia
Give 4 differentials for a cough in children
1) CF
2) LRTI / pneumonia
3) TB
4) Pertussis (whooping cough)
What are the most common objects that are inhaled (and cause problems)?
1) Food particles e.g. nuts, seeds
2) Toys e.g. beads
3) Small household items
4) Organic materials e.g. teeth
Is the right or left bronchus more frequently involved in inhaled foreign bodies?
Right (due to its more vertical orientation)
What is the classic triad of features with an inhaled foreign body?
1) Coughing paroxysms
2) Wheezing
3) Decreased breath sounds
Clinical features of inhaled foreign body?
- Sudden onset choking or gagging
- Coughing paroxysms
- Stridor (if located above vocal cords)
- Wheezing or asymmetric breath sounds
- Decreased air entry on auscultation
- Cyanosis or respiratory distress
- Tachypnoea and tachycardia
what are some complications of an inhaled foreign body?
Mechanical obstructoin of airflow –> atelectasis distal to the obstruction site
Granulation tissue formation and potential infection.
What is the preferred method for removal of the foreign body?
Bronchoscopy
What imaging may be useful in identifying the foreign body?
CXR
CT scan
How is a diagnosis of laryngomalacia made?
Laryngoscopy or bronchoscopy
When does laryngomalacia typically resolve?
Around 12-18 months as laryngeal muscles strengthen
