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