Laryngomalacia (congenital laryngeal stridor)

📌 Synonym: Congenital Laryngeal Stridor.

Definition: Excessive flaccidity of the supraglottic larynx, which is sucked in during inspiration producing stridor. It is the most common congenital abnormality of the larynx.

Clinical Features

• Onset: Manifests at birth or soon after.
• Duration: Usually disappears by 2 years of age.
• Symptoms:
  • Stridor: Inspiratory type. Sometimes associated with cyanosis.
  • Aggravating Factor: Stridor increases on crying.
  • Relieving Factor: Stridor subsides on placing the child in Prone Position.

Diagnosis

Tool: Flexible Laryngoscopy (Very useful).
*Note: Cannot be diagnosed in a paralyzed patient (requires active respiration).

Laryngoscopy Findings

• Epiglottis: Elongated and curled upon itself (Omega-shaped Ω).
• Aryepiglottic Folds: Floppy and short.
• Arytenoids: Prominent.

Management

1. Conservative

• Treatment for the vast majority of cases (as it is self-limiting).
• Reassurance to parents.

2. Surgical

Indicated only for severe respiratory obstruction or failure to thrive.

• Supraglottoplasty: Trimming of the floppy aryepiglottic folds/mucosa.
• Tracheostomy: Rarely required for severe obstruction.