What is laryngomalacia?
Laryngomalacia is a condition where floppy tissue above the vocal chords falls into the airway when a child breathes in, causing stridor. Stridor is a medical term for “noisy breathing.” The stridor from laryngomalacia is a high-pitched sound that is heard best when the child breathes in (inspiration).

What causes laryngomalacia?
Laryngomalacia is a defect that is present at birth. During fetal development, the rigid structures in the larynx may not fully develop. As a result, there is a weakness in these structures at birth, causing them to collapse during breathing, resulting in stridor. In children, laryngomalacia is the most common cause of stridor during infancy, and it typically improves with time.

What are the symptoms of laryngomalacia?
The major symptom of this disorder is the stridor (noisy breathing) that is predominately heard when the infant breathes in. It is usually loudest when the infant is feeding or sleeping, and may not be heard when the infant is crying. The stridor gets worse if the infant has an upper respiratory infection. When the stridor is severe, the baby will often have inward pulling of the skin, which can be seen in the neck just above the breastbone (sternum) and just below the ribs.

Many babies with laryngomalacia also have problems with feeding. Unlike adults, babies are able to both breathe and swallow at the same time. This is due to the position of the infant’s larynx, which is relatively high in the neck. Babies with moderate to severe laryngomalacia often have difficulty coordinating their feeding and breathing so they need to take frequent breaks during feeding. This can result in prolonged feeding times which is frustrating for both the child and parent. Sometimes the feeding difficulties are so severe the infant has trouble gaining weight.  

Moderate-severe laryngomalacia can result in sleeping difficulties and pauses in the breathing (apneic spells).  
How is laryngomalacia diagnosed?
In addition to a complete medical history and physical examination, a flexible laryngoscopy is typically performed in the clinic. During the laryngoscopy a small tube is passed through the nose and is used to view the larynx. Though the flexible laryngoscopy may be performed in the office, a more detailed evaluation of the airway may be performed in the operating room in select children (microlaryngoscopy and bronchoscopy). Sometimes a sleep study (polysomnogram) will be recommended to evaluate the extent of any sleep apnea.   

Treatment for laryngomalacia
In most cases, laryngomalacia is a harmless condition that resolves on its own, without medical intervention. Infants with more severe symptoms will sometimes be treated with a medication to control gastroesophageal reflux which is associated with laryngomalacia.  

If the baby is having moderate-severe stridor, and is having difficulties with feeding and/or sleep, a surgical procedure called supraglottoplasty may be recommended. This procedure involves viewing the larynx and trimming the excess aryepiglottic fold tissue to make more room for the air to pass through to the trachea, and is performed under general anesthesia. This surgery is performed through the mouth; there are no incisions on the outside of the body. The child typically needs to stay in the hospital for 1-3 nights after the surgery.  A supraglottoplasty often dramatically improves the child’s breathing, eating and sleeping.