Pediatric Laryngomalacia

Laryngomalacia is the most common cause of stridor, or “noisy breathing” in infants. It is a congenital condition although it may not appear until the first several days or weeks of life. Laryngomalacia is caused by redundancy of the tissue above the vocal cords. The redundant tissue collapses inward during inspiration and causes turbulence of the inspired air. The turbulence of the airflow causes stridor. 

Stridor is the most common symptom of laryngomalacia. The stridor worsens with agitation and with feeding but typically improves with sleep. Stridor may be the only symptom in mild cases of laryngomalacia. More severe cases also cause difficulty breathing and/or difficulty drinking. Some babies with laryngomalacia stop gaining weight because they cannot keep up with the increased calorie requirements of their labored breathing.

The diagnosis of laryngomalacia is best made by flexible fiberoptic laryngoscopy where a thin, flexible telescope is passed through the nose to examine the vocal cords and the airway above the vocal cords. The flexible laryngoscopy is completed in clinic and does not require general anesthesia.

Laryngomalacia is a “self-limited” condition since infants outgrow it, usually by 12 to 18 months of age. Approximately 15% of infants with laryngomalacia have severe enough airway or feeding problems that surgical treatment in indicated. Surgery involves removing a small bit of the collapsing, redundant tissue above the vocal cords. The procedure is called “supraglottoplasty” and should not affect the infant’s voice. Most babies who undergo supraglottoplasty are discharged from the hospital one to two days after the operation and show significant improvement in their breathing and feeding.