Laryngomalacia Clinical Presentation

Updated: Feb 12, 2019
  • Author: Stephanie Lovinsky-Desir, MD, MS; Chief Editor: Denise Serebrisky, MD  more...
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Presentation

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 sleep, during 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 and/or aspiration. Noises may increase during and after feeding.

  • 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]

Laryngomalacia may present primarily with snoring and/or sleep-disordered breathing. [3]  Also, swallowing dysfunction may be present in a significant proportion of children. [4] Therefore sleep disordered breathing and swallow dysfunction should be considered in children, older than 3 months, presenting with these upper airway complaints. [5]

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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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