Laryngomalacia is the most common cause of noisy breathing or STRIDOR in infants. Noisy breathing or STRIDOR is worse when the baby is active, feeding, crying or sleeping on his back.
What is laryngomalacia?
Laryngomalacia is a softening of the tissues of the larynx or the voice box above the vocal cords (also known as the supraglottic). The supraglottic includes the epiglottis, the aryepiglottic folds and the arytenoids as shown in the image. In laryngomalacia the epiglottis curls inwards and becomes omega shaped. The aryepiglottic folds are shortened.
All these problems leads to a floppy supraglottic. During breathing in (called inspiration), the supraglottic tissues fall in towards the vocal cords and obstruct it. This leads to difficulty in breathing and a sound produced during breathing called as “STRIDOR”.
At what age symptoms of laryngomalacia are seen?
Most infants born with laryngomalacia start having noisy breathing or “STRIDOR” during the first 2-4 weeks of life.
How is laryngomalacia diagnosed?
Laryngomalacia can be easily diagnosed by doing an airway examination also known as LARYNGOSCOPY. This involves a very thin flexible equipment which can be gently passed through the nose. During LARYNGOSCOPY the upper part of the airway or supraglottic is clearly seen. The epiglottis is seen to curl and the arytenoids are seen to fall into the voice box producing noisy breathing or STRIDOR. It is important to do a LARYNGOSCOPY to make a proper diagnosis.
How serious is LARYNGOMALACIA?
In most infants, laryngomalacia is not a serious condition. Although infants with laryngomalacia will have noisy breathing or STRIDOR, they are able to feed and grow well. In most infants, laryngomalacia resolves on its own by 12 to 18 months of age as the airway tissues mature. However, a small percentage of babies with laryngomalacia have problems with breathing, feeding and fail to grow well.
What are the serious symptoms which needs prompt attention?
The child needs urgent medical attention if the child is having any of these symptoms:
- Turns blue around the lips while breathing
- Poor weight gain
- Difficulty in feeding or choking while feeding
- Retractions seen in the neck or chest with breathing
How is Laryngomalacia treated?
Most children with laryngomalacia resolves without treatment by the time they are 12 to 18 months old. However, some children have severe laryngomalacia and might require surgical treatment. “Supraglottoplasty” is the surgery of choice in children with severe laryngomalacia. Symptoms that signal the need for “Supraglottoplasty” include: significant blue spells or cyanosis, frequent apneas or stoppage of breathing, poor weight gain, severe chest and neck retractions and low oxygen levels.