A 4-month-old infant presents to your office with noisy breathing. His mother notes it began at a few weeks of life and has gradually worsened. The noise is described as a high-pitched wheeze with inspiration. It worsens when the baby is feeding, crying, or supine. Laryngoscopy confirms the diagnosis of laryngomalacia (Figure 31-1). The infant is treated with acid suppression therapy. The infant–rsquo;s symptoms resolve by 18 months of age.

Laryngomalacia is a congenital abnormality of the larynx. It results in dynamic collapse of supraglottic structures leading to airway obstruction.

Laryngomalacias, Larynx chondromalacia.

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  Most common cause of stridor in newborns, affecting 45 to 75 percent of all infants with congenital stridor.¹

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  Exact etiology of laryngomalacia is unknown.

  
  
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  Theories include anatomic displacement of flaccid tissue, immaturity of cartilage, neurologic underdevelopment affecting laryngeal function, and tone.¹

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  Gastroesophageal and laryngopharyngeal reflux.

  
  
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  Neurologic disease.

  
  
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  Secondary airway lesions.

  
  
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  Congenital heart disease.

  
  
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  Congenital abnormalities/genetic disorders.

Clinical Features

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  Presents with inspiratory stridor that typically worsens with feeding, crying, supine, or positioning.

  
  
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  Symptoms begin within first few weeks of life, peak at 6 to 8 months, and usually resolve by 12 to 24 months.

  
  
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  Common associated symptoms include regurgitation, coughing, choking, and slow feeding.

  
  
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  Less common symptoms include respiratory distress, cyanosis, pectus excavatum, and failure to thrive.