Overview
Laryngomalacia is a common cause of congenital stridor in infants, characterised by a soft and floppy larynx due to immature laryngeal cartilages.
Epidemiology
- Laryngomalacia is the most common congenital cause of stridor in infants
Presentation
Infants present within the first few weeks of life (around 4-6 weeks, not necessarily at birth) with noisy breathing and stridor that are worse when supine, when feeding, or when agitated.
- They may have associated gastro-oesophageal reflux disease (GORD)
- Infants tend to be otherwise well and generally happy
- The infant’s cry is normal – this differentiates it from other laryngeal conditions such as vocal cord palsies
Investigations
- Flexible laryngoscopy:
- Shows supralaryngeal collapse during inspiration
Differential Diagnoses
Vocal cord palsy
- Although both may present similarly, vocal cord palsies present from birth, whereas laryngomalacia may not
- The cry may be abnormal (such as very high-pitched)/absent
- There may be problems with feeding such as choking and aspiration
Diagnosis
Management
Overview
Management consists of close observation and treatment of associated GORD.
Prognosis
- Most cases resolve spontaneously within 12-24 months
