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Laryngomalacia (lə-ring′gō- mə-lā′shə) or LM is best described as floppy tissue above the vocal cords that falls into the airway when a child breathes in.
Infants with LM have intermittent noisy breathing when breathing in that becomes worse with agitation, crying, excitement, feeding or position / sleeping on their back. These symptoms are often present at birth and are usually apparent within the first 10 days of life. However, noisy breathing may be present in babies up to 1 year of age.
Symptoms will often increase or get worse over the first few months after diagnosis, usually between 4-8 months of age. Most children outgrow the noisy breathing (stridor) by 12-18 months of age.
Other associated symptoms include:
Mild Laryngomalacia, Moderate Laryngomalacia and Severe Laryngomalacia.
Infants in this category have non-complicated laryngomalacia with typical noisy breathing when breathing in without significant airway obstructive events, feeding issues or other symptoms associated with laryngomalacia. These infants have noisy breathing that is annoying to the caregivers but does not cause other healthcare problems. These patients will usually outgrow the stridor by 12-18 months of age.
Even though your child may have mild laryngomalacia, it is still important to watch for signs or symptoms of it worsening.
Infants in this category have the following symptoms:
Even though your child may have moderate LM, it is still important to watch for signs and symptoms of it worsening.
Patients in this category often require surgery for treatment and to lessen the degree of symptoms. Your doctor may recommend surgery if your child has any of the following symptoms:
The condition is confirmed by a clinical examination and flexible laryngoscopy. Your child’s doctor may suspect that your child has LM by simply gathering his / her medical history.
This test involves placement of a lighted tube through the nose or mouth to look at the voice box. The doctor looks at the position of the tissue above the voice box to determine if it is floppy. At the same time, they will look for any other throat / voice box problems that may contribute to noisy breathing. This test is required to confirm a diagnosis.
During your child's test at the ENT Clinic at Cincinnati Children's, the lighted tube will be connected to a television camera so that parents or caregivers can see what the voice box looks like. While looking at the voice box, your doctor may ask you to feed your baby from a bottle to see how well your baby does with feeding, especially if there is a history of choking on food or spitting up.
Some children may have an additional problem that may contribute to the noisy breathing. The X-rays can screen for other possible causes of noisy breathing in the upper airway, windpipe, chest and lungs. Your doctor may recommend more studies if these tests are abnormal.
There is a strong link between gastroesophageal reflux disease (GERD) and laryngomalacia. All babies reflux, but children with laryngomalacia may have more than other babies. Acid reflux, if it reaches the upper portion of the swallowing tube (esophagus) and voice box region, can cause additional swelling of the floppy tissue seen in LM.
The Gastric Reflux Test (Multichannel Intraluminal Impedance Test) is performed to detect and record the number of times stomach contents come back into the esophagus and the relation of these episodes to symptoms (such as when a child cries, arches, coughs, gags, vomits, has chest pain). It also determines if the contents are acidic or not and how long they stay in the esophagus.
A thin light wire with an acid sensor as well as six to seven metal sensors is inserted through the nose into the lower part of the esophagus. The impedance probe is connected to a recorder box that the patient will carry with them for the duration of the study. Child life staff may be a useful resource to aid the patient and staff during placement of the probe, as this can be an uncomfortable procedure while awake.
Microscopic laryngoscopy and bronchoscopy (Micro L and B) is done in the operating room under general anesthesia by the ENT surgeon. The doctor looks at the voice box and windpipe with telescopes. Your doctor may recommend this test if the X-ray test shows something abnormal or if your doctor suspects additional airway problems.
An EGD is a diagnostic test done in the operating room under general anesthesia. The gastroenterologist looks at your child's esophagus and stomach with a lighted tube.
During an EGD, the doctor looks for signs of chronic inflammation from acid irritation that can occur in the stomach or the esophagus. Your doctor may recommend this if the pH probe is significantly abnormal or there is strong suspicion of significant GERD based on history and clinical examination.
When treating laryngomalacia, there are two surgical options; supraglottoplasty or tracheotomy.
Your doctor will most likely recommend a supraglottoplasty. The unneeded floppy tissue of the larynx is trimmed in the operating room with your child under general anesthesia. Your child may have a breathing tube in the nose through the voice box after surgery for at least one night.
Your child may need to have this operation done more than once. Having the operation may not make the noisy breathing go away completely, but it should improve your child’s breathing and will likely decrease the noise.
The other surgical option is the placement of a tracheotomy tube into the windpipe to bypass the floppy tissue of the larynx. Rarely is this operation done for laryngomalacia. Your surgeon will try to do the supraglottoplasty if it is appropriate and feasible for your child before recommending a tracheotomy. There are occasions and other health issues that make a tracheotomy the recommended surgical option.
If your child has an operation, he / she may still require treatment for gastroesophageal reflux during and after the operation. It is also important to monitor your child for signs and symptoms of worsening LM.
Take your child to the hospital if he / she:
Inform your child’s doctor about:
The Division of Adolescent and Young Adult Medicine provides comprehensive care for adolescents and young adults, ages 12–21. Our multidisciplinary team addresses medical, emotional, and social needs—helping teens navigate the challenges of growing up. With a focus on prevention, wellness, and specialized care, we support youth and families during this important time of change.
Last Updated 10/2024
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