What is laryngomalacia,Etiology of laryngomalacia, Common things, Clinical Presentation & Evaluation, management.
Noisy breathing ( stridor) , audible wheeze, change with position, spontaneous resolution. ( laryngomalacia)
Prolapse of the supraglottic structures into the laryngeal airway on inspiration.
Etiology of laryngomalacia
Etiology is not clear, possibly due to incomplete integration of laryngeal sensation with brain stem–mediated reflexes.
Common things with laryngomalacia .
Most of children with laryngomalacia have esophageal and laryngopharyngeal reflux.
Most common congenital anomaly of the upper airway.
Reflux of gastric contents causes inflammation and edema of the laryngeal mucosa, which can worsen laryngomalacia.
Most frequent congenital cause of stridor in infants
Clinical Presentation of laryngomalacia
Stridor is most pronounced at 2 to 4 months of life
Stridor developing in the first 2 weeks of life (not present at birth)
Despite stridor, most children are nontoxic-appearing and in no distress.
▪Worse with feeding, when lying supine, and during periods of agitation
Stridor often changes with position.
Improved with lying prone.
Hoarseness is not a symptom of laryngomalacia and may be suggestive of a vocal cord abnormality.
Some of the patients with laryngomalacia have severe laryngomalacia resulting in respiratory distress, failure to thrive, cyanotic episodes, acute life-threatening events, or an inability to tolerate oral feeds; these patients should be evaluated for concurrent airway lesions .
Diagnosis and Evaluation
Diagnosis is confirmed by direct visualization on flexible transnasal fiber-optic laryngoscopy
Laryngoscopy can be performed while the patient is awake, at bedside, or in the clinic
Findings of laryngomalacia on laryngoscopy.
Short, vertical aryepiglottic folds
Omega-shaped epiglottis, which may be retroflexed
Redundant arytenoid mucosa
Prolapse of redundant tissue overlying the arytenoid cartilage
May be inflammation and edema of laryngeal mucosa, secondary to reflux
Most often self-resolves between the ages of 12 and 18 months
Management of gastroesophageal reflux disease (GERD) with histamine 2 blockers or proton pump inhibitors
Children with severe laryngomalacia may require surgical intervention—supraglottoplasty.
In supraglottoplasty, redundant tissue over the arytenoids is removed, and both aryepiglottic folds are divided.