Is laryngomalacia a constant or sporadic condition?

From the Guidelines

Laryngomalacia is a constant condition, but its symptoms can appear sporadic or intermittent due to various factors such as feeding, crying, or position. The condition involves the softening of laryngeal tissues above the vocal cords, which collapse inward during inhalation, as noted in studies on its management 1. While the structural abnormality is always present, symptoms like inspiratory stridor often worsen during specific activities, creating the impression of symptom fluctuation. Most cases are mild to moderate and self-resolve by 12-24 months of age as the laryngeal cartilage strengthens naturally. For severe cases causing significant breathing difficulty, feeding problems, or poor weight gain, surgical intervention called supraglottoplasty may be necessary, as suggested by recent clinical practice guidelines 1. Key considerations for management include positioning infants on their stomachs or sides when supervised, feeding in an upright position, and monitoring for signs of respiratory distress, feeding difficulties, or poor weight gain that might indicate the need for medical intervention. Supraglottoplasty has been shown to improve outcomes in children with persistent obstructive sleep apnea (OSA) and laryngomalacia, with studies demonstrating clinically meaningful improvements in PSG parameters 1. However, the decision to proceed with surgery should be based on individual case assessment, considering the severity of symptoms and the potential benefits and risks of the procedure. In terms of morbidity, mortality, and quality of life, prioritizing early intervention and appropriate management strategies is crucial to prevent long-term complications and ensure the best possible outcomes for infants with laryngomalacia.

From the Research

Laryngomalacia Occurrence

• Laryngomalacia is a condition that can occur in infants, characterized by the weakening of the larynx, resulting in a collapse of the laryngeal cartilages into the airway during inspiration 2.
• The condition is often associated with stridor, which is usually noticed before 14 days of age and worsens with breathing and supine positioning 2.
• The severity of laryngomalacia can vary, with some infants experiencing mild symptoms, while others may develop severe complications, such as airway obstruction, hypoxia, and feeding problems 3, 2.

Disease Severity and Outcomes

• The spectrum of disease presentation, progression, and outcomes in laryngomalacia is varied, with some infants having inconsequential stridor, while others develop severe or life-threatening complications 3.
• Patient factors, such as APGAR scores, resting SAO2 level at time of presentation, and the presence of a secondary airway lesion, can influence disease severity 3.
• Medical co-morbidities, such as gastroesophageal reflux disease (GERD), neurologic disease, congenital heart disease, and genetic syndromes, can also contribute to disease severity and affect surgical outcomes 3.

Treatment and Management

• The treatment of laryngomalacia varies depending on the severity of the condition, with mild cases often being managed expectantly, while more severe cases may require surgical intervention, such as supraglottoplasty 2, 4, 5.
• Acid suppression therapy may be effective in improving symptoms in infants with GERD and laryngomalacia 3.
• Surgical management, such as supraglottoplasty, can be an effective alternative to tracheotomy in carefully selected patients with severe laryngomalacia 4, 5.