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Laryngomalacia Clinical Presentation

  • Author: Stephanie Lovinsky-Desir, MD; Chief Editor: Denise Serebrisky, MD  more...
 
Updated: Jun 18, 2015
 

History

The usual history in patients with laryngomalacia is of inspiratory noises that begin during the first 2 months of life. Sounds typically start at age 4-6 weeks, but they may begin in the nursery or as late as age 2-3 months.

  • Noises are inspiratory and may sound like nasal congestion, with which they are initially confused. However, the noises persist and no nasal secretions are present. The noise may be more high pitched, crowing stridor.
  • Noise is often increased when the baby is supine, during crying or agitation, during upper respiratory infection episodes, and, in some cases, during and after feeding.
  • The baby's cry is usually normal, unless concomitant reflux laryngitis is present.
  • Usually, no feeding intolerance is noted, although occasional choking or coughing with feedings may be noted if the baby has reflux.
  • The infant is usually happy and thriving.
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Physical

Upon examination, the baby is usually happy and appropriately interactive.

  • Mild tachypnea may be present.
  • Other vital signs are normal, and oxygen saturation is usually normal.
  • One can usually detect nasal airflow. The noise may be increased if the baby is placed supine.
  • The cry is normal. Hearing the baby's cry during the examination is important. An abnormal cry suggests pathology at or near the vocal cords.
  • The noise is purely inspiratory. The sounds may best be heard just above the sternal notch.
  • The rest of the examination findings are unremarkable, although another airway lesion may also be present in infants with laryngomalacia.[2]

A study found that because laryngomalacia may present primarily with snoring and/or sleep-disordered breathing and swallowing dysfunction in a significant proportion of children, the diagnosis must be considered in children, older than 3 months, presenting with these upper airway complaints.[3, 4]

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Causes

Laryngomalacia is a congenital abnormality of the larynx. The pathology is unknown. In cases in which redundant or tight tissue has been removed, it is histologically indistinct from normal tissue.

No genetic pattern is known.

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Contributor Information and Disclosures
Author

Stephanie Lovinsky-Desir, MD Assistant Professor in Pediatric Pulmonology, Morgan Stanley Children’s Hospital of New York-Presbyterian, Columbia University College of Physicians and Surgeons

Stephanie Lovinsky-Desir, MD is a member of the following medical societies: American Academy of Pediatrics, American Thoracic Society

Disclosure: Nothing to disclose.

Specialty Editor Board

Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Charles Callahan, DO Professor, Chief, Department of Pediatrics and Pediatric Pulmonology, Tripler Army Medical Center

Charles Callahan, DO is a member of the following medical societies: American Academy of Pediatrics, American College of Chest Physicians, American College of Osteopathic Pediatricians, American Thoracic Society, Association of Military Surgeons of the US, Christian Medical and Dental Associations

Disclosure: Nothing to disclose.

Chief Editor

Denise Serebrisky, MD Associate Professor, Department of Pediatrics, Albert Einstein College of Medicine; Director, Division of Pulmonary Medicine, Lewis M Fraad Department of Pediatrics, Jacobi Medical Center/North Central Bronx Hospital; Director, Jacobi Asthma and Allergy Center for Children, Jacobi Medical Center

Denise Serebrisky, MD is a member of the following medical societies: American Thoracic Society

Disclosure: Nothing to disclose.

Additional Contributors

Michael R Bye, MD Professor of Clinical Pediatrics, State University of New York at Buffalo School of Medicine; Attending Physician, Pediatric Pulmonary Division, Women's and Children's Hospital of Buffalo

Michael R Bye, MD is a member of the following medical societies: American Academy of Pediatrics, American College of Chest Physicians, American Thoracic Society

Disclosure: Nothing to disclose.

References
  1. Edmondson NE, Bent JP 3rd, Chan C. Laryngomalacia: the role of gender and ethnicity. Int J Pediatr Otorhinolaryngol. 2011 Dec. 75(12):1562-4. [Medline].

  2. Dickson JM, Richter GT, Meinzen-Derr J, Rutter MJ, Thompson DM. Secondary airway lesions in infants with laryngomalacia. Ann Otol Rhinol Laryngol. 2009 Jan. 118(1):37-43. [Medline].

  3. Cooper T, Benoit M, Erickson B, El-Hakim H. Primary Presentations of Laryngomalacia. JAMA Otolaryngol Head Neck Surg. 2014 May 8. [Medline].

  4. Boggs W. Laryngomalacia Commonly Presents With Snoring or Swallowing Dysfunction. Reuters Health Information. Available at http://www.medscape.com/viewarticle/825146. May 15, 2014; Accessed: June 16, 2015.

  5. Powitzky R, Stoner J, Fisher T, Digoy GP. Changes in sleep apnea after supraglottoplasty in infants with laryngomalacia. Int J Pediatr Otorhinolaryngol. 2011 Oct. 75(10):1234-9. [Medline].

  6. Unal E, Oran B, Baysal T, et al. Pulmonary arterial pressure in infants with laryngomalacia. Int J Pediatr Otorhinolaryngol. 2006 Dec. 70(12):2067-71. [Medline].

  7. Richter GT, Rutter MJ, deAlarcon A, Orvidas LJ, Thompson DM. Late-onset laryngomalacia: a variant of disease. Arch Otolaryngol Head Neck Surg. 2008 Jan. 134(1):75-80. [Medline].

  8. Revell SM, Clark WD. Late-onset laryngomalacia: a cause of pediatric obstructive sleep apnea. Int J Pediatr Otorhinolaryngol. 2011 Feb. 75(2):231-8. [Medline].

  9. Chan DK, Truong MT, Koltai PJ. Supraglottoplasty for occult laryngomalacia to improve obstructive sleep apnea syndrome. Arch Otolaryngol Head Neck Surg. 2012 Jan. 138(1):50-4. [Medline].

  10. Richter GT, Thompson DM. The surgical management of laryngomalacia. Otolaryngol Clin North Am. 2008 Oct. 41(5):837-64, vii. [Medline].

  11. Whymark AD, Clement WA, Kubba H, Geddes NK. Laser epiglottopexy for laryngomalacia: 10 years' experience in the west of Scotland. Arch Otolaryngol Head Neck Surg. 2006 Sep. 132(9):978-82. [Medline].

  12. Erickson B, Cooper T, El-Hakim H. Factors Associated With the Morphological Type of Laryngomalacia and Prognostic Value for Surgical Outcomes. JAMA Otolaryngol Head Neck Surg. 2014 Sep 4. [Medline].

  13. [Guideline] Institute for Clinical Systems Improvement (ICSI). Preventive services for children and adolescents. 2008 Oct. [Full Text].

  14. Bertrand P, Navarro H, Caussade S, et al. Airway anomalies in children with Down syndrome: endoscopic findings. Pediatr Pulmonol. 2003 Aug. 36(2):137-41. [Medline].

  15. Cotton RT, Richardson MA. Congenital laryngeal anomalies. Otolaryngol Clin North Am. 1981 Feb. 14(1):203-18. [Medline].

  16. Denoyelle F, Mondain M, Gresillon N, et al. Failures and complications of supraglottoplasty in children. Arch Otolaryngol Head Neck Surg. 2003 Oct. 129(10):1077-80; discussion 1080. [Medline].

  17. Fauroux B, Pigeot J, Polkey MI, et al. Chronic stridor caused by laryngomalacia in children: work of breathing and effects of noninvasive ventilatory assistance. Am J Respir Crit Care Med. 2001 Nov 15. 164(10 Pt 1):1874-8. [Medline]. [Full Text].

  18. Gessler EM, Simko EJ, Greinwald JH. Adult laryngomalacia: an uncommon clinical entity. Am J Otolaryngol. 2002 Nov-Dec. 23(6):386-9. [Medline].

  19. Kay DJ, Goldsmith AJ. Laryngomalacia: a classification system and surgical treatment strategy. Ear Nose Throat J. 2006 May. 85(5):328-31, 336. [Medline].

  20. Mancuso RF, Choi SS, Zalzal GH, Grundfast KM. Laryngomalacia. The search for the second lesion. Arch Otolaryngol Head Neck Surg. 1996 Mar. 122(3):302-6. [Medline].

  21. Manning SC, Inglis AF, Mouzakes J, Carron J, Perkins JA. Laryngeal anatomic differences in pediatric patients with severe laryngomalacia. Arch Otolaryngol Head Neck Surg. 2005 Apr. 131(4):340-3. [Medline].

  22. Midulla F, Guidi R, Tancredi G, et al. Microaspiration in infants with laryngomalacia. Laryngoscope. 2004 Sep. 114(9):1592-6. [Medline].

  23. Sivan Y, Ben-Ari J, Soferman R, DeRowe A. Diagnosis of laryngomalacia by fiberoptic endoscopy: awake compared with anesthesia-aided technique. Chest. 2006 Nov. 130(5):1412-8. [Medline].

  24. Smith JL, Sweeney DM, Smallman B, Mortelliti A. State-dependent laryngomalacia in sleeping children. Ann Otol Rhinol Laryngol. 2005 Feb. 114(2):111-4. [Medline].

  25. Thompson DM. Abnormal sensorimotor integrative function of the larynx in congenital laryngomalacia: a new theory of etiology. Laryngoscope. 2007 Jun. 117(6 Pt 2 Suppl 114):1-33. [Medline].

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Laryngomalacia: The epiglottis is small and curled on itself (omega-shaped). Approximation of the posterior edges of the epiglottis contributes to the inspiratory obstruction. (From B Benjamin, Atlas of Paediatric Endoscopy, Oxford University Press, NY, 1981, with permission.)
 
 
 
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