Differential Diagnosis for Breathing Difficulty on Extension of Neck, Relieved on Flexion

• Single Most Likely Diagnosis
  • Laryngomalacia: This condition is characterized by softening of the tissues of the larynx, which can cause partial airway obstruction, particularly when the neck is extended. Flexion of the neck can help to alleviate the obstruction, leading to relief of breathing difficulty.
• Other Likely Diagnoses
  • Vocal Cord Paralysis: Unilateral or bilateral vocal cord paralysis can cause breathing difficulties, especially when the neck is extended, as the paralyzed cord may obstruct the airway. Flexion can help to move the cord out of the way, improving breathing.
  • Tracheomalacia: Similar to laryngomalacia, tracheomalacia involves softening of the tracheal cartilages, which can lead to tracheal collapse and breathing difficulties when the neck is extended.
• Do Not Miss Diagnoses
  • Epidottitis: Although less common, epiglottitis is a life-threatening condition that requires immediate attention. It can cause severe breathing difficulties, and while the relationship with neck extension is not as clear, any signs of airway obstruction should prompt consideration of this diagnosis.
  • Retropharyngeal Abscess: This condition involves an abscess in the tissues at the back of the throat, which can cause airway obstruction. While the symptoms may not be directly related to neck extension, any suspicion of an abscess should be thoroughly investigated due to the risk of airway compromise.
• Rare Diagnoses
  • Cervical Spine Anomalies: Certain anomalies of the cervical spine, such as Klippel-Feil syndrome, can affect the airway indirectly by altering the anatomy of the neck and throat, potentially leading to breathing difficulties in specific positions.
  • Thyroid Masses: Large thyroid masses can compress the trachea, leading to breathing difficulties. While the symptoms may not typically vary with neck position, significant masses could potentially cause positional breathing difficulties.