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Laryngomalacia in children: Treatment, symptoms, advice and help

 

Definition


Laryngomalacia is a condition in which the tissues of the entrance of the larynx collapse into the airway when the child breathes in. This gives rise to noisy breathing.


Incidence/Age


Laryngomalacia is the commonest cause of noisy breathing in early life. It usually starts during the first two weeks of life and gradually recovers. It can go on to the age of 2 or even older in some cases.


Causes


The precise cause is unknown. Most children with laryngomalacia have no other health problems but do have a rather slit-like laryngeal entrance which is susceptible to getting sucked in as air passes through. Occasionally a type of laryngomalacia will occur in children who have other health problems, particularly conditions in which they lack full muscular control of the lining of the throat.


Signs & Symptoms


The principal feature of laryngomalacia is noisy breathing (stridor) occurring when the child is breathing in. It is usually low pitched and has a chugging quality, is very variable and may come and go, is worse while the child is asleep and their muscles are relaxed. The child's cry is usually normal. In more severe cases there may be difficulty coordinating feeding and breathing and this may lead to failure to thrive. Frequenting vomiting is commonly seen in more severe cases. Babies with airway problems frequently have rib recession (sucking in of the lower ribs as the baby breathes in).


Complications of the Disorder


Laryngomalacia can occasionally cause severe failure to thrive. It is rarely a risk to life but may be aggravated by respiratory infections and necessitate hospitalisation.


Tests


Children are investigated to ascertain the cause of their noisy breathing. X-rays are usually performed. These include neck and chest x-rays and a barium swallow X-ray.


It may be possible to examine the baby's larynx with a fibreoptic telescope while it is awake but in most cases with more than trivial symptoms a microlaryngoscopy and bronchoscopy will be required.


Treatment


Do nothing


Most cases of laryngomalacia are mild and will get better on their own.


A hard cervical collar which supports the neck will often help to improve the airway.


Aryepiglottoplasty (Supraglottoplasty)


This is an operation which is often performed at the same time as a diagnostic laryngoscopy and bronchostopy. Using an operating microscope, the tissue which flops into the laryngeal entrance is trimmed. The operation takes about half an hour and can often be performed as day surgery. There can be a temporary worsening of breathing overnight or postoperative sore throat, but usually the after effects are minor. Aryepiglottoplasty is usually very effective in improving laryngomalacia although it does not always take away the noisy breathing completely.


Tracheostomy


It is rarely necessary to perform tracheostomy for uncomplicated laryngomalacia in a child who has no other problems.


Outcome


Laryngomalacia is a self limiting condition which most children grow out of within a few months. The noisy breathing may become louder for a few months as the child becomes bigger and stronger but then starts to diminish. Laryngomalacia is much less common after the age of one year although it is not rare for it to persist to the age of two or even longer.