Laryngomalacia Follow-up

  • Author: Michael R Bye, MD; Chief Editor: Michael R Bye, MD   more...
 
Updated: Feb 24, 2010
 

Further Inpatient Care

No inpatient care is necessary in patients with laryngomalacia unless the baby has clinically significant hypoxemia or apnea.

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Further Outpatient Care

Unless supplemental oxygen is required for oxygen saturation less than 90%, no home therapy is necessary.

The usual well-child visits should be performed.

Immunizations should not be delayed because of airway noise.

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Inpatient & Outpatient Medications

No medications are necessary.

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Deterrence/Prevention

Laryngomalacia is not a preventable lesion and does not appear to run in families.

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Complications

Poor oxygenation that requires supplemental oxygen

Alveolar hypoventilation that requires surgery or positive pressure ventilation

Apnea

Increased likelihood of gastroesophageal reflux

Pulmonary hypertension

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Prognosis

Prognosis is excellent. Most babies outgrow the condition by their second birthday, many by the first. In some cases, even though the signs and symptoms dissipate, the pathology persists. Such patients may have stridor with exercise later in life.

Laryngomalacia may be more common in children with Down syndrome, in whom it may persist beyond the second birthday.

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Contributor Information and Disclosures
Author

Michael R Bye, MD  Professor of Clinical Pediatrics, Division of Pulmonary Medicine, Columbia University College of Physicians and Surgeons; Attending Physician, Pediatric Pulmonary Medicine, Morgan Stanley Children's Hospital of New York Presbyterian, Columbia University Medical Center

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

Disclosure: Merck Honoraria Speaking and teaching

Specialty Editor Board

Girish D Sharma, MD  Associate Professor of Pediatrics, Rush Medical College; Director, Section of Pediatric Pulmonology and Rush Cystic Fibrosis Center, Rush University Medical Center

Girish D Sharma, MD is a member of the following medical societies: American Academy of Pediatrics, American College of Chest Physicians, American Thoracic Society, and Royal College of Physicians of Ireland

Disclosure: Nothing to disclose.

Mary L Windle, PharmD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy, Pharmacy Editor, eMedicine

Disclosure: Nothing to disclose.

Charles Callahan, DO  Professor, Deputy Chief of Clinical Services, Walter Reed 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, and Christian Medical & Dental Society

Disclosure: Nothing to disclose.

Mary E Cataletto, MD  Associate Director, Division of Pediatric Pulmonology, Winthrop University Hospital; Professor of Clinical Pediatrics, State University of New York at Stony Brook; Director of Children's Sleep Services, Winthrop University Hospital

Mary E Cataletto, MD is a member of the following medical societies: American Academy of Pediatrics and American College of Chest Physicians

Disclosure: Shering Plough Pharmaceuticals Honoraria Consulting

Chief Editor

Michael R Bye, MD  Professor of Clinical Pediatrics, Division of Pulmonary Medicine, Columbia University College of Physicians and Surgeons; Attending Physician, Pediatric Pulmonary Medicine, Morgan Stanley Children's Hospital of New York Presbyterian, Columbia University Medical Center

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

Disclosure: Merck Honoraria Speaking and teaching

References

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

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

  3. 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].

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

  5. 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].

  6. 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].

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

  8. 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].

  9. 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].

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

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

  12. 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].

  13. 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].

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

  15. 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].

  16. 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].

  17. 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].

 
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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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