Birth Defects Respiratory Laryngomalacia

Laryngomalacia is a congenital defect, or a structural problem present from birth. It affects the larynx, sometimes called the voice box.

The larynx is composed primarily of cartilage. In laryngomalacia, soft cartilage of the larynx can collapse inward during breathing. While laryngomalacia usually resolves on its own, the condition can lead to a variety of complications. In rare cases, surgery may be required to address laryngomalacia.

Structure of the Larynx

The larynx, or voice box, is a series of structures, including the vocal cords and the structures surrounding them. The larynx plays an important role in swallowing, breathing and talking. It is bordered on top by the pharynx (the throat) and below by the trachea (the “windpipe”), which goes down to the lungs.

The larynx is made up of several types of cartilage that provide structure for the larynx, help with vocal cord movement, and protection for the vocal folds and the airway during swallowing. Laryngomalacia exists when the floppy cartilage above the vocal cords collapses into the airway during inward breathing.

Laryngomalacia in Infants: Symptoms and Diagnosis

he primary symptom of laryngomalacia in babies is noisy breathing when breathing in. Also called stridor, this noisy breathing is particularly noticeable when the child is agitated or excited, or when the baby is lying down.

Laryngomalacia can be classified according to severity:

  • Mild: Noisy breathing without other symptoms or complications
  • Moderate: Stridor, along with airway obstruction from laryngeal cartilage, that may result in trips to the hospital, vomiting or spitting up and trouble feeding
  • Severe: Stridor, prolonged apnea (stopping of breathing), cyanosis (bluish skin), trouble feeding and failure to thrive, need for supplemental oxygen and possible complications from oxygen deprivation.

Laryngomalacia in infants is diagnosed through a physical exam, and confirmed with a laryngoscopy. In this test, a small camera scope is inserted through the nose or mouth and down the back of the throat. This allows the doctor to see the larynx and diagnose any problems that may exist. The collapse of the laryngeal cartilages in laryngomalacia can be seen in a laryngoscopy.

Laryngomalacia Treatment

Treatment depends on the severity of the laryngomalacia. Infants typically grow out of mild or moderate laryngomalacia by the age of 12 to 18 months, as the laryngeal structures mature.

In cases of more severe laryngomalacia, a doctor may recommend surgery. After a physical exam and laryngoscopy, the doctor will suggest appropriate treatment, including ways to deal with the gastroesophageal reflux that often accompanies laryngomalacia.

Resources

Cincinnati Children’s Hospital. (n.d.). Laryngomalacia (infantile). Retrieved April 22, 2010, from: http://www.cincinnatichildrens.org/health/l/laryngomalacia-Infantile/.

Emory University. (n.d.) Pharynx and larynx. Retrieved April 22, 2010, from: http://www.emory.edu/ANATOMY/AnatomyManual/pharynx.html.

Children’s Memorial Hospital. (n.d.). Laryngomalacia. Retrieved April 22, 2010, from: http://www.childrensmemorial.org/depts/otolaryngology/nosethroat5.aspx.