Laryngomalacia

1. Epidemiology
   1. Most common cause of chronic Stridor in infants
   2. Onset within first month of life and continues until 18-24 months of age
2. Pathophysiology
   1. Weak Larynx that collapses with inspiration, leading to partial airway obstruction
3. Signs
   1. Inspiratory Stridor
   2. Provocative factors (Increases Stridor)
      1. Crying or other Agitation
      2. Exertion
      3. Feeding
      4. Upper Respiratory Infection
   3. Palliative factors (Decreases Stridor)
      1. Prone position
      2. Neck extension
   4. Severe obstructive signs (rare)
      1. Failure to Thrive
      2. Apnea
      3. Cyanosis
      4. Pulmonary Hypertension
4. Diagnosis
   1. Typically diagnosed on clinical features alone
   2. Bronchoscopy
      1. Indicated in severe cases
5. Course
   1. Onset of symptoms in first month of life
   2. Self limited (resolves spontaneously by 18-24 months)
   3. Rarely progresses to severe obstruction
6. Management
   1. Reassurance
   2. Control Pediatric Gastroesophageal Reflux Disease
   3. Surgery (Epiglottoplasty or Supraglottoplasty) Indications in Severe Obstruction (rarely indicated)
      1. Significant Respiratory Distress
      2. Apnea
      3. Failure to Thrive
7. References
   1. Dahan, Campbell and Melville (2020) Crit Dec Emerg Med 34(11): 3-10
   2. Nussbaum (1990) Chest 98:942-4 [PubMed]