laryngomalacia

What is Laryngomalacia?

Laryngomalacia is a congenital softening of the tissues in the larynx (voice box) above the vocal cords, making it the most common cause of noisy breathing in infancy [1]. It is a dynamic lesion that results in collapse of the supraglottic structures during inspiration, leading to airway obstruction [2].

Characteristics and Symptoms

Laryngomalacia causes the soft tissues in the larynx to fall into the airway when a child inhales, making it difficult for them to breathe normally [4]. The main symptom of laryngomalacia is noisy breathing, also known as stridor, which is a high-pitched sound heard when a child inhales [6]. Stridor may sound worse when a child breathes in and can be a sign of severe laryngomalacia [8].

Symptoms of Severe Laryngomalacia

In severe cases of laryngomalacia, symptoms can include feeding difficulties, faltering growth, respiratory distress, and apnoeas (pauses in breathing) [9]. These symptoms are often a sign that the condition is more serious and requires immediate medical attention.

References: [1] Context result 1 [2] Context result 3 [4] Context result 4 [6] Context result 6 [8] Context result 8 [9] Context result 9

Common Signs and Symptoms of Laryngomalacia

Laryngomalacia, a condition affecting infants, can manifest in various ways. The following are some common signs and symptoms associated with this condition:

• Noisy Breathing (Stridor): An audible wheeze or high-pitched sound when the baby inhales.
• Difficulty Feeding: Infants may experience difficulty feeding due to the soft and floppy larynx, leading to poor weight gain.
• Poor Weight Gain: Failure to gain weight at a normal rate can be an indication of severe laryngomalacia.
• Vomiting or Spitting Up: Some infants may vomit or spit up food due to difficulty swallowing.
• Choking on Food: In severe cases, food may enter the lungs, leading to choking.
• Pauses in Breathing (Apnea): Long pauses in breathing can be a sign of more severe laryngomalacia.

Additional Symptoms

In some cases, infants with laryngomalacia may experience:

• Difficulty Swallowing: Trouble swallowing food or liquids due to the soft and floppy larynx.
• Long Pauses in Breathing (Apnea): Prolonged pauses in breathing can be a sign of severe laryngomalacia.
• Bluish Skin Hue (Cyanosis): In severe cases, infants may develop a bluish skin hue due to lack of oxygen.

References

• [1] Signs of more severe laryngomalacia include difficulty feeding, increased effort in breathing, poor weight gain, pauses in the breathing, or frequent spitting up. (Source: Search Result 1)
• [2] Laryngomalacia sounds like a high-pitched squeak (stridor) when your baby breathes in. It usually isn't serious. But in severe cases, it can cause breathing and feeding difficulties. (Source: Search Result 2)
• [3] Signs and symptoms include noisy breathing (stridor), difficulty feeding, poor weight gain, vomiting or spitting up, choking on food, and pauses in breathing. (Source: Search Result 3)
• [4] Severe laryngomalacia symptoms include difficulty swallowing, long pauses in breathing, bluish skin hue, and pulling of food into the lungs when coughing. (Source: Search Result 4)

Laryngomalacia can be diagnosed through various tests, which are used to confirm the clinical features and symptoms presented by the patient.

Common Diagnostic Tests for Laryngomalacia

• Nasopharyngolaryngoscopy (NPL): This is the main test used to diagnose laryngomalacia. An otolaryngologist uses a scope with a tiny camera to examine the throat and airways.
• Impedance Test: While not specific to laryngomalacia, this test can help identify any issues related to gastroesophageal reflux disease (GERD), which is often linked to laryngomalacia.
• Flexible Laryngeal Endoscopy: This procedure involves passing a small flexible camera through the nose to examine the throat and airways. It's commonly used to diagnose laryngomalacia.
• Direct Rigid Laryngoscopy Under Anesthesia: In some cases, this test may be performed under anesthesia to get a better view of the airways.

Other Diagnostic Tests

• X-ray of the neck
• Airway fluoroscopy
• Microlaryngoscopy and bronchoscopy (MLB)
• Esophagogastroduodenoscopy (EGD) and pH probe: These tests may be used to rule out other conditions or to assess any potential complications.

References

• [1] Impedance Test is mentioned as a test that can help identify issues related to GERD, which is often linked to laryngomalacia.
• [2] Nasopharyngolaryngoscopy (NPL) is the main test used to diagnose laryngomalacia.
• [3] Flexible Laryngeal Endoscopy is a procedure that can be used to confirm the diagnosis of laryngomalacia.
• [4] Direct Rigid Laryngoscopy Under Anesthesia may be performed under anesthesia to get a better view of the airways.

Treatment Options for Laryngomalacia

Laryngomalacia, a condition characterized by soft and floppy tissues in the upper airway, can be managed with various treatment options. While most cases resolve on their own before the infant reaches 18 months of age, some may require medical intervention.

• Anti-reflux medications: In cases where laryngomalacia occurs with gastroesophageal reflux (GERD), medication like proton pump inhibitors (PPIs) or H2 blockers may be prescribed to help manage symptoms [1][3].
• Positioning and lifestyle changes: For mild and moderate cases, positioning the infant on their back or stomach, and thickening the baby's formula can help alleviate symptoms [7][9].
• Surgical supraglottoplasty: In severe cases of laryngomalacia associated with obstructive sleep apnea, surgical intervention may be necessary to remove excess tissue and improve breathing [2].

It is essential to note that drug therapy is not a standard treatment for laryngomalacia, and most cases resolve without medical intervention [4]. However, in some instances, medication may be recommended to control associated symptoms or acid reflux from the stomach.

References:

[1] Context result 1 [2] Context result 2 [3] Context result 3 [4] Context result 4 [7] Context result 7 [9] Context result 9

Understanding Differential Diagnosis in Laryngomalacia

Laryngomalacia, a congenital softening of the tissues above the vocal cords, is a common cause of noisy breathing in infancy. When it comes to diagnosing and managing this condition, differential diagnosis plays a crucial role.

What is Differential Diagnosis?

Differential diagnosis refers to the process of identifying and ruling out other possible causes of a patient's symptoms or condition. In the context of laryngomalacia, differential diagnosis involves considering various conditions that may present with similar symptoms, such as stridor (noisy breathing) and dyspnea (difficulty breathing).

Conditions to Consider in Differential Diagnosis

Some conditions that should be considered in the differential diagnosis of laryngomalacia include:

• Paradoxical vocal fold motion: A condition where the vocal folds move in a way that can cause airway obstruction.
• Laryngeal stenosis: A narrowing of the airway caused by scarring or other tissue changes.
• Tracheomalacia: A softening of the trachea (windpipe) that can lead to breathing difficulties.
• Foreign body aspiration: The presence of a foreign object in the airway, which can cause obstruction and difficulty breathing.

Key Points to Consider

When considering differential diagnosis for laryngomalacia, it's essential to keep the following points in mind:

• Clinical history: A thorough understanding of the patient's medical history, including any previous respiratory issues or symptoms.
• Flexible laryngoscopy: A diagnostic tool that allows healthcare providers to visualize the airway and identify potential obstructions or abnormalities.
• Imaging studies: X-rays, CT scans, or other imaging tests may be used to rule out other conditions or confirm a diagnosis of laryngomalacia.

References

• [4] Laryngomalacia is a congenital softening of the tissues above the vocal cords and is a common cause of noisy breathing in infancy.
• [8] Idiopathic laryngomalacia was associated with the following comorbidities: GERD, obstructive sleep apnea (OSA), or allergic rhinitis.
• [9] Laryngomalacia differential diagnosis, treatment options, and images at Epocrates Online.

By considering these factors and conditions in differential diagnosis, healthcare providers can accurately diagnose and manage laryngomalacia, ensuring the best possible outcomes for affected patients.