Laryngo- means the larynx (or voice box) and malacia means floppy, so laryngomalacia means a floppy larynx.
1. The structures of the larynx, including the epiglottis are made of cartilage. If you feel your baby's ear (which is also made of cartilage), you will notice that it is much softer than in an adult. In some infants, the cartilage can be so soft and curled (omega shaped) that it flops over the vocal folds each time the infant breathes.
2. In addition, the arytenoids (the ball-like joints on which the vocal folds rotate) can have redundant tissue that flops over the airway. In some infants, gastric reflux can exacerbate this redundant tissue.
3. Finally, the aryepiglottic folds (the tissue connecting the epiglottis to the arytenoids) can be short, pulling the epiglottis and arytenoids close together.
These three elements can partially obstruct the airway causing a high-pitched noise that we call stridor.
What Is Stridor?
Stridor is a high pitched, squeaky noise that can be heard when there is narrowing of the airway at the level of the larynx (voice box) or trachea (windpipe). It is like water flowing through a river. When the river is wide, the water is relatively calm and quiet. When the river becomes narrow, the water becomes more turbulent, resulting in rapids, which are much noisier. Stridor is the sound of turbulent air flow.
What Are the Symptoms of Laryngomalacia?
The symptoms of laryngomalacia can start at or shortly after birth. Your baby will make a soft, high-pitched noise when he or she breathes in. This is known as inspiratory stridor. The noise may become louder when your baby is feeding, lying down, or crying. You may also notice that the baby's chest looks like it is sucking in at the area between the collarbones (suprasternal retractions) or between where the bottom ribs meet (substernal retractions).
How Do You Diagnose Laryngomalacia?
Laryngomalacia is diagnosed by flexible nasolaryngoscopy.
How Do You Treat Laryngomalacia?
As the cartilages strengthen, most infants will grow out of laryngomalacia by around 16 months of age. So often, no intervention is needed. If your infant has redundant arytenoid tissue, he or she may benefit from reflux medication.
Some infants with laryngomalacia have so much difficulty coordinating breathing and eating that they cannot gain weight appropriately. Other infants have so much obstruction of their airway that they cannot get enough oxygen and turn blue. In these cases there are surgeries that we can do to help them.
What Surgeries Are There to Treat Laryngomalacia?
If your infant has laryngomalacia and is having difficulty with feeding such that they cannot gain weight or they are having difficulty getting enough oxygen, your otolaryngologist will probably want to take a closer look at the larynx (voice box) and trachea (windpipe) in the operating room. This procedure is called a direct laryngoscopy and bronchoscopy. The surgeon will be looking for any other structural anomalies of the airway that could be contributing to the problems.
Your otolaryngologist may then proceed with a procedure called a supraglottoplasty. There are many ways to perform this procedure: scissors, laser, microdebrider, etc. It typically consists of dividing the aryepiglottic folds to allow the epiglottis and arytenoids to spring apart and reducing the tissue of the arytenoids. The manipulation of the laryngeal (voice box) tissues can cause swelling, which can make the breathing temporarily worse before it gets better.