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Laryngomalacia – comprehensive overview

Laryngomalacia is a congenital condition characterized by the softening of the tissues of the larynx (voice box), leading to partial airway obstruction.

Epidemiology

  • 1. Most common cause of stridor:

    Laryngomalacia is the most common cause of stridor in infants.

  • 2. Age:

    Symptoms typically appear within the first few weeks of life and peak around 6-8 months.

  • 3. Prevalence:

    Estimated to affect 1 in 2,000 to 1 in 4,000 births.

Pathology and Pathophysiology

  • 1. Softening of laryngeal tissues:

    The epiglottis, arytenoids, and aryepiglottic folds are floppy and prone to collapse.

  • 2. Airway obstruction:

    The soft tissues can collapse into the airway, causing partial obstruction.

Symptoms and Signs

  • 1. Stridor:

    High-pitched sound while breathing, often worse with feeding, crying, or lying on back.

  • 2. Respiratory distress:

    Difficulty breathing, retractions, and use of accessory muscles.

  • 3. Feeding difficulties:

    Trouble feeding, choking, or gagging.

  • 4. Failure to thrive:

    Poor weight gain or weight loss.

Grading of Laryngomalacia

  • 1. Mild:

    Minimal symptoms, often managed with conservative treatment.

  • 2. Moderate:

    More pronounced symptoms, such as stridor (high-pitched sound while breathing), feeding difficulties, and mild respiratory distress.

  • 3. Severe:

    Significant airway obstruction, causing severe respiratory distress, feeding difficulties, and potential complications like failure to thrive or apnea.

Features of Severe Laryngomalacia

  • 1. Severe stridor:

    Loud, high-pitched sound while breathing, often accompanied by significant respiratory distress.

  • 2. Respiratory distress:

    Difficulty breathing, retractions (pulling in of chest or abdomen), and use of accessory muscles.

  • 3. Feeding difficulties:

    Trouble feeding, choking, or gagging due to airway obstruction.

  • 4. Failure to thrive:

    Poor weight gain or weight loss due to feeding difficulties and increased energy expenditure.

  • 5. Apnea:

    Pauses in breathing, which can be life-threatening.

  • 6. Cyanosis:

    Bluish discoloration of the skin due to inadequate oxygenation.

Investigations

  • 1. Flexible laryngoscopy:

    Visual examination of the larynx to assess tissue collapse.

  • 2. Polysomnography:

    Sleep study to evaluate oxygen saturation and respiratory patterns.

  • 3. Imaging studies:

    X-rays or CT scans may be used to rule out other conditions.

Complications

  • 1. Respiratory failure:

    Severe airway obstruction can lead to respiratory failure.

  • 2. Failure to thrive:

    Poor weight gain or weight loss due to feeding difficulties.

  • 3. Apnea:

    Pauses in breathing, which can be life-threatening.

Management

  • 1. Conservative management:

    For mild cases, treatment may involve monitoring, positioning, and feeding modifications.

  • 2. Surgical intervention:

    For severe cases, surgery (supraglottoplasty) may be necessary to relieve airway obstruction.

  • 3. Multidisciplinary care:

    Collaboration between pediatricians, ENT specialists, and other healthcare professionals is essential for managing laryngomalacia.

If you suspect laryngomalacia, consult a pediatrician or an ENT specialist for proper diagnosis and treatment.

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