Laryngomalacia is a congenital abnormality of the larynx (voice box) wherein these cartilages are floppy, resulting in them getting sucked in over the larynx during breathing.Laryngomalacia is the most common cause of inspiratory stridor (noisy breathing) in infants.

The usual history is of inspiratory noises that begin during the first 4 to 6 weeks of life. The noise is often increased during crying or agitation, during upper respiratory infection episodes, and in some cases, during and after feeds. This noise may be increased if the baby is placed on its back and improves when the baby is placed on its stomach or on extension of the neck.

If the baby has normal cry, normal weight gain, normal development, and purely inspiratory noise that developed within the first 2 months of life, then no further workup is necessary. Parents may be reassured that laryngomalacia is the most likely diagnosis.
Laryngoscopy (often along with a bronchoscopy) is the best way to confirm the diagnosis and ensure that there are no other conditions contributing. The paediatric ENT surgeon will carry out the laryngoscopy in the OPD with a flexible laryngoscope to visualize the airway directly and confirm the diagnosis.

This reveals an omega-shaped epiglottis, short aryepiglottic folds and bulky arytenoid cartilages all of which prolapse over the larynx during inspiration. The vocal cords are normal.

In majority of cases, the prognosis is excellent and the condition improves gradually with time. The stridor usually disappears by 2 years of age. If the baby has more noise and is uncomfortable when asleep, these babies may sleep prone.

For severe cases in which the laryngomalacia interferes with breathing enough to impair normal eating, growth, and development, surgical management may be required. A laryngoplasty / supraglottoplasty is performed using microlaryngoscopy and laser in which the support structures are tightened, and loose tissue is partially divided or removed.

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