Laryngomalacia

One of the most common causes of noisy breathing (Stridor) in infants/babies. Noisy breathing can turn many parents really anxious and worried.

Most cases of laryngomalacia is not a serious condition. Generally it resolves with out any intervention or treatment by the age of 18 to 20 months. However there is a small percentage of babies who fails to gain weight , shows difficulty in breathing and taking feeds. These are the children who will require consultation of a Pediatric ENT specialist and some intervention.

It is mainly caused by softening of cartilages above the level of vocal cords, resulting in collapse of the supraglottic structures or structures above the vocal thus obstructing the airway partially. In my experience, majority of mild cases have a significant improvement with change in positioning of the baby. In mild cases, the best treatment modality in my opinion is a very clear communication with the parents about the condition, possible time for recovery and reassurance that their baby is going to outgrow the condition over time without any complication.

In moderate to severe cases, a dynamic airway evaluation is required to assess the seriousness of the condition. There is high chance of missing the diagnosis if evaluation is done under general anesthesia as it eliminates the dynamic component of breathing which is mainly affected in Laryngomalacia. Another important point to be kept in mind during the evaluation is to rule out Vocal Cord Palsy.

Once the diagnosis is attained, a critical decision with regard to intervention has to be made. In my experience, an excellent result has been attained in most cases of moderate to severe laryngomalacia with Aryepiglottoplasty .

Aryepiglottoplasty is a simple procedure done by dividing the aryepiglottic fold using cold cold steel or coablator. The result of the surgery is usually appreciated within 24 hours of surgery as the edema settles. There have been some isolated cases in my practice which required further intervention and evaluation.

Signs which triggers a red flags are - Child stops breathing for more than 10 seconds - Lips or finger tips turning blue during noisy breathing or during cry - Pulling in of neck or chest even after re-positioning or awakening of the child.