Introduction

Laryngomalacia is the most common congenital laryngeal abnormality characterised by flaccidity of the supraglottic structures. The larynx is soft and floppy as a result and collapses during breathing.

Classification

Types
  • Type 1: tightening of the aryepiglottic folds
  • Type 2: redundant tissue in the supraglottic region
  • Type 3: associated with other disorders such as neuromuscular weakness or gastro-oesophageal reflux disease

Epidemiology

  • Incidence: 10.00 cases per 100,000 person-years
  • Most commonly see in infants
  • Sex ratio: more common in males 1.6:1
<1 1-5 6+ 16+ 30+ 40+ 50+ 60+ 70+ 80+

Clinical features

Features
  • Inspiratory stridor: high-pitched and crowing. This is usually intermittent, occurring in the supine position e.g. when the child lies on its back, when feeding or when agitated
  • Symptoms increase in severity during the first 8 months but tend to resolve by 18-24 months
  • Respiratory distress, failure to thrive and cyanosis are rare

Investigations

Investigations
  • Oxygen saturation should be monitored and blood gases taken if there is desaturation
  • Laryngoscopy and bronchoscopy are only indicated if there are severe features, or if there is diagnostic difficulty

Management

Management
  • 99% of cases usually resolve spontaneously by 18-24 months
  • Symptomatic relief may be provided by hyperextending the neck during episodes of stridor
  • Surgical intervention is only required with severe respiratory distress e.g. tracheostomy, laryngoplasty, excision of redundant mucosa, laser epiglottopexy or laser division of the aryepiglottic folds