From the Guidelines
Predictive examination factors for laryngomalacia include inspiratory stridor, which is the hallmark clinical finding, and can be elicited by exercise or other stimuli, as noted in studies such as 1 and 1. Other key factors include:
- Inspiratory noise that begins within the first few weeks of life
- Symptoms that worsen over the first few months before gradually improving
- Feeding difficulties such as regurgitation or poor weight gain
- Physical examination may reveal suprasternal retractions during inspiration and a high-pitched, crowing inspiratory noise Flexible laryngoscopy remains the gold standard diagnostic tool, revealing omega-shaped epiglottis, shortened aryepiglottic folds, and prolapse of the arytenoid cartilages during inspiration, as seen in studies such as 1 and 1. Associated conditions that may predict more severe disease include:
- Gastroesophageal reflux disease
- Neurological disorders
- Congenital heart disease Most cases (90%) are mild and self-limiting, resolving by 12-24 months of age as the laryngeal cartilage matures and strengthens, as noted in 1 and 1. However, severe cases presenting with significant respiratory distress, cyanotic episodes, failure to thrive, or cor pulmonale require prompt surgical intervention, typically supraglottoplasty, as recommended in 1. The underlying pathophysiology involves immature, flaccid supraglottic structures that collapse during inspiration, creating airway obstruction and the characteristic stridor, as described in 1 and 1. It is essential to consider these factors and associated conditions to provide appropriate management and improve outcomes for patients with laryngomalacia, as emphasized in 1 and 1.
From the Research
Predictive Examination Factors for Laryngomalacia
The predictive examination factors for Laryngomalacia include:
- Patient factors such as APGAR scores, resting SAO2 level at time of presentation, and the presence of a secondary airway lesion 2
- Gastroesophageal reflux disease (GERD) and laryngopharyngeal reflux (LPR) which contribute to feeding symptoms 2
- Medical co-morbidities such as neurologic disease, congenital heart disease, a genetic syndrome, or anomaly which contribute to disease severity and affect surgical outcomes 2
- The presence of multiple medical co-morbidities which can increase the likelihood of requiring revision supraglottoplasty or tracheostomy 2
Disease Severity and Outcomes
The severity of Laryngomalacia and outcomes of management can be influenced by:
- The presence of GERD/LPR and medical co-morbidities 2
- The severity of airway obstruction and the presence of life-threatening complications 3
- The effectiveness of surgical interventions such as supraglottoplasty and tracheostomy 2, 3
Diagnostic and Treatment Factors
The diagnosis and treatment of Laryngomalacia can involve: