Summary about Disease
Laryngomalacia is a congenital (present at birth) condition where the soft tissues of the larynx (voice box) collapse inward during inhalation, obstructing the airway. It's the most common cause of noisy breathing (stridor) in infants. In most cases, it resolves on its own as the child grows.
Symptoms
Stridor (high-pitched, noisy breathing) – usually louder when the baby is lying on their back, crying, or feeding.
Symptoms often appear within the first few weeks or months of life.
Difficulty feeding.
Gastroesophageal reflux (GERD) can worsen symptoms.
Cyanosis (bluish discoloration of the skin) – rare, but indicates severe obstruction.
Apnea (pauses in breathing) – rare, but indicates severe obstruction.
Failure to thrive (in severe cases).
Causes
The exact cause is not fully understood. It is believed to be due to:
Immature cartilage in the larynx.
Neuromuscular problems affecting the larynx.
Shortened aryepiglottic folds (tissue connecting the epiglottis to the arytenoid cartilages).
Medicine Used
Acid Reflux Medications: If gastroesophageal reflux (GERD) is present or suspected, medications like proton pump inhibitors (PPIs) or H2 blockers may be prescribed to reduce stomach acid production.
In severe cases: Surgical intervention like supraglottoplasty may be needed, during this procedure medications like anesthetics and pain relief are used.
Is Communicable
Laryngomalacia is not communicable. It is a structural abnormality present at birth and cannot be spread from person to person.
Precautions
Positioning: Elevate the head of the baby's crib or bassinet to help ease breathing.
Feeding: Feed the baby slowly and in an upright position to minimize reflux and aspiration.
Avoid irritants: Keep the baby away from smoke and other respiratory irritants.
Monitor: Closely monitor the baby's breathing, feeding, and weight gain. Seek immediate medical attention if there are signs of respiratory distress (cyanosis, severe retractions, apnea).
Follow-up: Regular follow-up appointments with a pediatrician or ENT specialist are crucial to monitor the condition and ensure it is resolving as expected.
How long does an outbreak last?
Laryngomalacia is not an "outbreak" since it's a congenital condition. Symptoms typically peak around 6-8 months of age and then gradually improve as the airway matures. Most cases resolve by 12-18 months. However, some mild symptoms may persist longer in some children.
How is it diagnosed?
History and Physical Exam: The doctor will ask about the baby's symptoms and perform a physical exam, listening to the baby's breathing.
Flexible Laryngoscopy: This is the primary diagnostic tool. A thin, flexible scope with a camera is inserted through the nose to visualize the larynx and observe the collapse of tissues during breathing.
Bronchoscopy: In some cases, a bronchoscopy may be performed to further evaluate the airway.
Timeline of Symptoms
Birth - Few Weeks/Months: Symptoms typically begin within the first few weeks or months of life.
6-8 Months: Symptoms usually peak during this period. Stridor is often loudest and feeding difficulties may be most pronounced.
12-18 Months: Symptoms generally start to improve as the larynx matures.
Beyond 18 Months: In most cases, symptoms have resolved or are significantly reduced. A small percentage may have persistent mild symptoms.
Important Considerations
Severity: Laryngomalacia ranges in severity from mild to severe. Most cases are mild and resolve without intervention.
Co-existing Conditions: Laryngomalacia can sometimes be associated with other medical conditions, such as gastroesophageal reflux (GERD), neurological problems, or other airway abnormalities. Addressing these co-existing conditions can improve the overall outcome.
Second Opinion: If you are concerned about your child's diagnosis or treatment plan, seeking a second opinion from another ENT specialist is always a reasonable option.
Emergency Care: Parents should be educated on the signs of respiratory distress and when to seek immediate medical attention.