eMedicine Specialties > Pediatrics: General Medicine > Pulmonology
Laryngomalacia: Differential Diagnoses & Workup
Updated: Jul 24, 2009
- Overview
- Differential Diagnoses & Workup
- Treatment & Medication
- Follow-up
- Multimedia
Differential Diagnoses
| Airway Foreign Body | Respiratory Papillomatosis |
| Congenital Stridor | Subglottic Stenosis |
| Croup | |
| Gastroesophageal Reflux | |
| Hypocalcemia |
Other Problems to Be Considered
Laryngeal cyst
Laryngeal web
Laryngeal stenosis
Vascular ring
Vocal cord paralysis
Laryngeal hemangioma
Workup
Laboratory Studies
- Oxygen saturation should be monitored in patients with laryngomalacia.
Imaging Studies
- Fluoroscopy
- Fluoroscopy of the airway may be performed by a pediatric radiologist.
- The cartilages may be observed collapsing on inspiration on a lateral view of the airway.
- Laryngoscopy and bronchoscopy
- These studies are the best studies used to confirm the diagnosis. However, in an infant with typical inspiratory noises (worse when supine) who have a normal cry and normal growth and development, clinical diagnosis is not unreasonable.
- A pediatric pulmonologist or pediatric otorhinolaryngologist may perform flexible laryngoscopy or bronchoscopy. Bronchoscopy under anesthesia has been shown to be more sensitive and specific than bronchoscopy in infants who are awake.
- Direct visualization of the airway reveals an omega-shaped epiglottis that prolapses over the larynx during inspiration.
- Enlarged arytenoid cartilages that prolapse over the larynx during inspiration may also be present.
More on Laryngomalacia |
| Overview: Laryngomalacia |
Differential Diagnoses & Workup: Laryngomalacia |
| Treatment & Medication: Laryngomalacia |
| Follow-up: Laryngomalacia |
| Multimedia: Laryngomalacia |
| References |
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References
[Guideline] Institute for Clinical Systems Improvement (ICSI). Preventive services for children and adolescents. Oct 2008;[Full Text].
Unal E, Oran B, Baysal T, et al. Pulmonary arterial pressure in infants with laryngomalacia. Int J Pediatr Otorhinolaryngol. Dec 2006;70(12):2067-71. [Medline].
Richter GT, Thompson DM. The surgical management of laryngomalacia. Otolaryngol Clin North Am. Oct 2008;41(5):837-64, vii. [Medline].
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. Sep 2006;132(9):978-82. [Medline].
Bertrand P, Navarro H, Caussade S, et al. Airway anomalies in children with Down syndrome: endoscopic findings. Pediatr Pulmonol. Aug 2003;36(2):137-41. [Medline].
Cotton RT, Richardson MA. Congenital laryngeal anomalies. Otolaryngol Clin North Am. Feb 1981;14(1):203-18. [Medline].
Denoyelle F, Mondain M, Gresillon N, et al. Failures and complications of supraglottoplasty in children. Arch Otolaryngol Head Neck Surg. Oct 2003;129(10):1077-80; discussion 1080. [Medline].
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. Nov 15 2001;164(10 Pt 1):1874-8. [Medline]. [Full Text].
Gessler EM, Simko EJ, Greinwald JH. Adult laryngomalacia: an uncommon clinical entity. Am J Otolaryngol. Nov-Dec 2002;23(6):386-9. [Medline].
Kay DJ, Goldsmith AJ. Laryngomalacia: a classification system and surgical treatment strategy. Ear Nose Throat J. May 2006;85(5):328-31, 336. [Medline].
Mancuso RF, Choi SS, Zalzal GH, Grundfast KM. Laryngomalacia. The search for the second lesion. Arch Otolaryngol Head Neck Surg. Mar 1996;122(3):302-6. [Medline].
Manning SC, Inglis AF, Mouzakes J, Carron J, Perkins JA. Laryngeal anatomic differences in pediatric patients with severe laryngomalacia. Arch Otolaryngol Head Neck Surg. Apr 2005;131(4):340-3. [Medline].
Midulla F, Guidi R, Tancredi G, et al. Microaspiration in infants with laryngomalacia. Laryngoscope. Sep 2004;114(9):1592-6. [Medline].
Sivan Y, Ben-Ari J, Soferman R, DeRowe A. Diagnosis of laryngomalacia by fiberoptic endoscopy: awake compared with anesthesia-aided technique. Chest. Nov 2006;130(5):1412-8. [Medline].
Smith JL, Sweeney DM, Smallman B, Mortelliti A. State-dependent laryngomalacia in sleeping children. Ann Otol Rhinol Laryngol. Feb 2005;114(2):111-4. [Medline].
Thompson DM. Abnormal sensorimotor integrative function of the larynx in congenital laryngomalacia: a new theory of etiology. Laryngoscope. Jun 2007;117(6 Pt 2 Suppl 114):1-33. [Medline].
Further Reading
Keywords
omega-shaped epiglottis, laryngeal cartilage, malformation of the laryngeal cartilage, chronic inspiratory noise, gastroesophageal reflux, reflux laryngitis, hypoxemia, hypoventilation, choking, laryngomalacia, congenital stridor, swollen arytenoid cartilages, pulmonary artery hypertension, hypoxemia, hypoventilation, feeding problems, treatment, diagnosis
Differential Diagnoses & Workup: Laryngomalacia