Laryngomalacia

Laryngomalacia, or floppy larynx syndrome, (also known as congenital laryngeal Stridor) is the result of the softness/weakness of the laryngeal structures (epiglottis) and tissues (aryepiglottic folds) causing them to collapse into the airway.  Symptoms of Laryngomalacia are: a low-pitched or squeaky sound when breathing in which gets louder when an infant is lying on his/her back, crying or agitated, feeding, playful or excited or when his/her neck is flexed forward.  Hoarseness in the voice and the caving in of the chest due to blockage of the air flow are also common symptoms, it can also cause sleeping problems, weight loss or poor weight gain due to feeding difficulties (an infant can choke or gag when feeding and tires easily (which means an infant can take over 30mins to take 4-6 ounces of formula) and regurgitate food, which is known as reflux), they can pause when breathing, have increased heart rate and cyanosis (turning pale or blue).

Laryngomalacia is a defect present at birth caused by the structures in the larynx not developing fully (it is thought to be related to the immature and incomplete development of the muscles and nerve supply to the voice box), it is usually detected in the first few days of life or up to two months but not at birth, it may worsen over the next few months and is usually at its worst at six months but it should gradually improve.  It can be helped by laying an infant on his/her front with his/her neck hyper extended (chin up), sitting an infant upright or at a 30 degree angle.  Most infants are symptom free by 24 months although the Stridor can be present for up to four years.  Infants with Laryngomalacia are at risk from developing gastro-oesophageal reflux.  Occasional inflammatory changes can be observed in the larynx, which is referred to as reflux laryngitis.

Microlaryngoscopy and Bronchoscopy (MLB)

These are tests that allow the doctor to look at the larynx and bronchi using a small telescope (endoscope).  This procedure is done under general anaesthetic, after the anaesthetic the infant’s larynx is sprayed with a local anaesthetic and the doctor then inserts the endoscope into the infant’s airway through the mouth.  After the investigation the infant will have a sore throat and will not be allowed to eat or drink for three hours afterwards.  It usually takes around a week for an infant to recover fully from this procedure.

Aryepiglottoplasty

This procedure is used when surgery is needed after having Microlaryngoscopy and Bronchoscopy investigations.  It is a laser treatment which trims the relevant structure or tissue which is causing the infant’s Laryngomalacia.

Links to other sites on this topic

www.drhull.com/EncyMaster/L/laryngomalacia

www.gpnotebook.co.uk/laryngomalacia

www.ich.ucl.ac.uk/mlb