From the Guidelines
Laryngomalacia is a condition characterized by the collapse of redundant supra-arytenoidal mucosa, specifically type 1 laryngomalacia, which can cause inspiratory collapse and lead to obstructive sleep apnea (OSA) in children. This condition is often diagnosed using drug-induced sleep endoscopy (DISE) and can be treated with supraglottoplasty, a surgical procedure that involves the division of shortened aryepiglottic folds and trimming of redundant supra-arytenoidal mucosa 1. The symptoms of laryngomalacia can vary, but it often presents with stridor, a high-pitched squeaky noise during inhalation, which can worsen when the child is feeding, crying, or lying on their back.
Key Characteristics of Laryngomalacia
- The condition is caused by the collapse of soft tissues in the larynx, including the epiglottis and arytenoid cartilages
- It can lead to obstructive sleep apnea (OSA) in children, particularly those with persistent OSA after adenotonsillectomy 1
- Supraglottoplasty is a common treatment for laryngomalacia, which can improve symptoms and reduce the risk of OSA
- The procedure involves the use of cold steel instruments, microdebrider, or laser to trim excess tissue and relieve airway obstruction 1
Treatment and Management
- Mild cases of laryngomalacia may not require treatment beyond monitoring and positioning the child upright during feeding
- More severe cases may require supraglottoplasty to relieve airway obstruction and improve symptoms
- Parents should watch for signs of breathing distress, poor feeding, or blue coloration, which would require immediate medical attention 1
From the Research
Definition and Presentation of Laryngomalacia
- Laryngomalacia is defined as the collapse of supraglottic structures during inspiration 2
- It is the most common laryngeal disease of infancy and the most common cause of stridor in infants 2, 3, 4, 5, 6
- Laryngomalacia presents with stridor, a high-pitched, musical, vibrating, multiphase inspiratory noise, typically appearing within the first 10 days of life 2
- Signs of severity include poor weight gain, dyspnoea, episodes of respiratory distress, obstructive sleep apnoea, and/or episodes of suffocation while feeding or feeding difficulties 2
Diagnosis and Management
- Diagnosis is based on systematic office flexible laryngoscopy to confirm laryngomalacia and exclude other causes of supraglottic obstruction 2
- Rigid endoscopy under general anaesthesia may be performed in certain cases, such as absence of laryngomalacia on flexible laryngoscopy or presence of signs of severity 2
- Management may include expectant management, acid suppression treatment, or surgical intervention, such as supraglottoplasty, depending on the severity of symptoms and presence of comorbidities 3, 4, 5, 6