8.2 Laryngomalacia
Key Features
Laryngomalacia is the most common cause of stridor in infants (accounts for ~ 75% of infantile stridor).
Often self-limited; most patients are symptom-free by 12 to 24 months of age.
Treatment for 90% of cases is expectant observation.
Its etiology is unknown.
Laryngomalacia is a temporary physiologic dysfunction due to abnormal flaccidity of laryngeal tissues or incoordination of supralaryngeal structures.
Epidemiology
Laryngomalacia is the most common congenital airway abnormality. Overall, laryngomalacia accounts for 60% of cases of chronic laryngeal stridor. It is more common among males than females (2:1). Concomitant airway abnormalities are found in 12 to 37% of patients. Comorbidities, including prematurity, cardiovascular malformation, and neurologic and congenital or chromosomal abnormalities, are present in ~ 41% of patients.
Clinical
Signs and Symptoms
Most commonly, patients present with intermittent inspiratory stridor that is relieved by neck extension and a prone position. Stridor is exacerbated by agitation. In extreme cases, patients become cyanotic, have a poor oral intake, have chest retractions, and develop pectus excavatum.
Differential Diagnosis
Other causes of stridor in the early pediatric age group include:
Unilateral or bilateral vocal fold paralysis
Laryngeal cleft
Choanal atresia
Airway hemangioma
Laryngeal web
Airway foreign body
Acquired or congenital subglottic stenosis
Craniofacial anomalies
Glottic cysts
Laryngeal reflux
Saccular cyst
Tracheomalacia
Papillomatosis
Acid-reflux disorders (see Chapter 5.5) have been documented in up to 80% of patients with laryngomalacia.
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