II. Epidemiology
- Most common cause of chronic Stridor in infants
- Onset within first month of life and continues until 18-24 months of age
III. Pathophysiology
- Congenital disorder in infants resulting in Noisy Breathing
- Weak Larynx that collapses with inspiration, leading to partial airway obstruction and Stridor
IV. Signs
- Inspiratory Stridor
- Provocative factors (Increases Stridor)
- Crying or other Agitation
- Exertion
- Feeding
- Upper Respiratory Infection
- Palliative factors (Decreases Stridor)
- Prone position
- Neck extension
- Severe obstructive signs (rare)
V. Associated Conditions
- Poor feeding and poor weight gain (88% of cases)
- Suck-swallow-breath sequence is poorly coordinated in moderate to severe Laryngomalacia
VI. Diagnosis
- Typically diagnosed on clinical features alone
- Bronchoscopy
- Indicated in severe cases
VII. Course
- Onset of symptoms in first month of life
- Severe cases present in the first 2 weeks of life
- Self limited (resolves spontaneously by 18-24 months in most cases)
- Rarely progresses to severe obstruction
VIII. Management
- Reassurance
- Control Pediatric Gastroesophageal Reflux Disease
- Surgery (Epiglottoplasty or Supraglottoplasty)
- Indications in Severe Obstruction (rarely indicated)
- Significant Respiratory Distress
- Apnea
- Failure to Thrive
- Supraglottoplasty
- Effective in 80% of cases in improving Swallowing and decreasing aspiration risk
- Indications in Severe Obstruction (rarely indicated)
IX. References
- Dahan, Campbell and Melville (2020) Crit Dec Emerg Med 34(11): 3-10
- Nussbaum (1990) Chest 98:942-4 [PubMed]