Laryngomalacia
Mary E. Cataletto, MD, MMM, FAAP, FCCP
Introduction/Etiology/Epidemiology
•Laryngomalacia (LM) is the most common cause of stridor in newborns and the most common laryngeal disease of infancy.
•LM is defined as collapse of supraglottic structures (epiglottis and/or arytenoids) during inspiration.
•LM is thought to be caused by neuromuscular alteration in laryngeal tone and resultant prolapse of the supra-arytenoid tissue and supraglottic collapse, which causes airflow obstruction.
•The epidemiology of LM is poorly defined.
•In a 2012 systematic review of LM and acid reflux, Hartl and Chadha identified an almost 10-fold increase in reflux prevalence in infants with moderate to severe LM, as compared to those with mild LM. The prevalence rate for gastroesophageal reflux in infants with severe LM was 65% in this review. However, direct causality has not been established.
•Acquired LM can also occur and should be considered in children who present with sleep-associated stridor, upper airway obstruction, and apnea.
Signs and Symptoms
Stridor
•See Chapter 2, The Pediatric Pulmonary Physical Examination, for evaluation of stridor.
•Timing is predominantly inspiratory but may also be biphasic.
•Quality is high pitched, musical, and vibrating.
•Approximately 10% of infants may have respiratory distress, aspiration, apnea, cyanotic episodes, or poor weight gain with difficulty feeding.
•Stridor of LM often worsens with agitation, crying, feeding, and lying in the supine position.
Associated Findings and Comorbidities
•Feeding difficulty can occur with coughing, choking, regurgitation, vomiting, and slow oral intake. Aspiration or cyanotic episodes can also occur.
•Gastroesophageal reflux disease (GERD) and laryngopharyngeal reflux disease (LPRD) may be present.
Clinical Course
•Clinical course is affected by multiple factors, including laryngeal anatomy and supraglottic tone, as well as the presence of mucosal edema and decreased airflow.
•
Stay updated, free articles. Join our Telegram channel
Full access? Get Clinical Tree
