eMedicine Specialties > Pediatrics: General Medicine > Pulmonology

Laryngomalacia: Treatment & Medication

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
Contributor Information and Disclosures

Updated: Jul 24, 2009

Treatment

Medical Care

  • In more than 99% of cases, the only treatment necessary is time. The lesion gradually improves, and noises disappear by age 2 years in virtually all infants. The noise steadily increases over the first 6 months, as inspiratory airflow increases with age. Following this increase, a plateau often occurs with a subsequent gradual disappearance of the noise. In some cases, the signs and symptoms dissipate, but the pathology may persist into childhood and adulthood. In those cases, symptoms or signs may recur with exercise or sometimes with viral infections.
  • If the baby has more noise and is uncomfortable when asleep, they may sleep prone, although one must then be careful to avoid soft bedding, pillows, and blankets. Initially, infants with laryngomalacia were exempt from the American Academy of Pediatrics' "Back to Sleep" campaign. More recently, the recommendations have been changed to indicate that these babies should sleep supine to reduce the likelihood of sudden infant death. Guidelines for preventive services for children and adults have been established.1
  • If the baby has clinically significant hypoxemia (defined as a resting oxygen saturation <90%), supplemental oxygen should be administered. Recent data suggest infants with laryngomalacia and hypoxemia may more readily develop pulmonary hypertension.2 Therefore, children with hypoxemia should periodically undergo evaluation for pulmonary hypertension.
  • If the baby has normal cry, normal weight gain, normal development, and purely inspiratory noise that developed within the first 2 months of life, then no further workup may be necessary. Parents may be told that laryngomalacia is the most likely diagnosis, and they can be assured of its natural history.
  • If the picture is not obvious or if the parents are not completely reassured, diagnostic procedures include fluoroscopy and flexible laryngoscopy or bronchoscopy. Flexible bronchoscopy with the child anesthetized is more specific and sensitive than flexible bronchoscopy in a child who is awake.

Surgical Care

  • In severe cases in which the laryngomalacia interferes with ventilation enough to impair normal eating, growth, and development, a surgical approach is possible.3
  • Operations include simple tracheotomy or laryngoplasty in which support structures are tightened and excess tissue on the epiglottis is removed. Laser epiglottopexy has been successful.4

Consultations

  • If the parents require another opinion or if the lesion is clinically severe, consultation with a pediatric pulmonologist or pediatric otorhinolaryngologist may help.

Diet

  • No diet restrictions are necessary.

Activity

  • No activity restrictions are necessary.

Medication

Drug therapy is not currently a component of the standard of care for laryngomalacia. In more than 99% of cases, the only treatment necessary is time. The lesion gradually improves, and noises disappear by age 2 years in virtually all cases. See Treatment.

More on Laryngomalacia

Overview: Laryngomalacia
Differential Diagnoses & Workup: Laryngomalacia
Treatment & Medication: Laryngomalacia
Follow-up: Laryngomalacia
Multimedia: Laryngomalacia
References
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References

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

  2. 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].

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

  4. 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].

  5. 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].

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

  7. 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].

  8. 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].

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

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

  11. 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].

  12. 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].

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

  14. 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].

  15. 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].

  16. 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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Further Reading

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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

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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

Medical Editor

Girish D Sharma, MD, Associate Professor, Department of Pediatrics, Rush University Medical Center, Rush Children's Hospital; Director of Pediatric Pulmonary Section and Rush Cystic Fibrosis 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.

Pharmacy Editor

Mary L Windle, PharmD, Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy, Pharmacy Editor, eMedicine
Disclosure: Pfizer Inc Stock Investment from financial planner; Avanir Pharma Stock Investment from financial planner ; WebMD Salary and stock Employment and investment from financial planner

Managing Editor

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.

CME Editor

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

 
 
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