Laryngomalacia

Question 1

What is Laryngomalacia?

Answer 1

• where the supraglottic larynx (the part of the larynx above the vocal cords) is structured in a way that allows it to cause partial airway obstruction
• flaccidity of the supraglottic structures - the larynx is soft and floppy as a result and collapses during breathing
• ⇒ leads to chronic stridor on inhalation → were the larynx flops across the airway as the infant breathes in

Question 2

What is the role of the aryepiglottic folds?

Answer 2

there are 2 aryepiglottic folds at the entrance of the larynx - they run between the epiglottis and the arytenoid cartilages → they’re either side of the airway and their role is to constrict the opening of the airway to prevent fluid entering the larynx and trachea

Question 3

What structural changes are seen in Laryngomalacia?

Answer 3

• in this condition, the aryepiglottic folds are shortened which pulls on the epiglottis and changes its shape to a characteristic omega shape
• in laryngomalacia, the tissue surrounding the supraglottic larynx is soft and has less tone, meaning it can flop across the airway
• this happens particularly during inspiration, as the air moving through the larynx to the lungs pulls the floppy tissue across the airway to partially occlude it → this generates the whistling sound

Question 4

What age does Laryngomalacia commonly occur?

Answer 4

It commonly occurs in infants, peaking at 6 months.

Question 5

What is the presentation of Laryngomalacia?

Answer 5

Inspiratory stridor, which is usually intermittent and more prominent when feeding, upset, lying on their back, or during upper respiratory tract infections. It can cause difficulties with feeding.

Question 6

What is the management for Laryngomalacia?

Answer 6

The problem resolves as the larynx matures and grows. No interventions are usually needed, and the child typically grows out of the condition. Rarely, tracheostomy might be needed, and surgery is an option to alter the tissue in the larynx.