Though it sounds quite serious, laryngomalacia is actually quite common in infants, and under most circumstances is not a serious condition. Known also as a "soft voice box," laryngomalacia is a congenital irregularity that causes a person to make odd noise, or stridor, when breathing. Sometimes the noise can be heard by anyone near the person, though in other cases it is only heard with the use of a stethoscope. Laryngomalacia may occur in adults, but it is far more common in infants and young children.
Laryngomalacia is caused when the soft tissue and cartilage surrounding the voice box, or larynx, is too weak to support the pressure of breath, causing the tissue to flap inwards during breathing. The stridor can sound like high pitched squeaking or congestion-related snoring. Sometimes the area at the base of the throat can be seen to sink in with breath, though with other cases of infant laryngomalacia, the area below the diaphragm will be seen to drop.
The main laryngomalacia symptom in infants is stridor upon inhalation, beginning during the first two months of life, usually while the baby is lying down, crying, or in distress. The stridor may also be heard when the baby has a cold or upper respiratory infection. Often, laryngomalacia is confused with colic. Sometimes a baby is brought to the doctor because the parents believe the child has a lingering cold with no nasal discharge.
To aid in diagnosis, a doctor may need to insert a lighted, flexible tube down the patient's throat far enough to view the voice box. He will then be able to determine if patient has mild, moderate, or severe laryngomalacia. The seriousness of the condition will help determine a treatment plan.
In most cases, the only treatment needed for infant laryngomalacia is time. As the baby grows, the stridor will get worse, then slowly start to taper off as the tissue and cartilage begin to strengthen and support the larynx. As long as the baby is feeding well, has normal weight gain, and is developing normally, there is little that a doctor will need to do. In moderate cases, breathing monitors may be used at home while the baby sleeps to make sure he or she is breathing properly.
Laryngomalacia surgery is an option when the patient cannot eat or breathe normally. One surgical procedure, called a tracheotomy, involves cutting an opening in the neck to create a direct airway to the windpipe. Alternately, a laryngoplasty may be performed to reinforce the support structures around the voice box and remove any extra tissue around the larynx.
Laryngomalacia is often connected with acid reflux, and eating and resting positions may need to be altered to prevent reflux. If the reflux is severe enough to bring stomach acid to the voice box, it can cause swelling and make the noise during inhaling worse. If repositioning doesn’t work, the doctor may prescribe medicine to treat the reflux.
