Laryngomalacia: Diagnosis and management

BackgroundLaryngomalacia is the term most widely used to describe the “inward collapse of supraglottic structures of the larynx during inspiration”. It is considered to be the most common cause of congenital stridor. Laryngomalacia usually presents by high pitched inspiratory stridor which is often present at birth and is usually noticed by 2 weeks of age. Stridor in laryngomalacia is usually positionally dependent and is worse at times of increased work of breathing. Diagnosis depends mainly on visualization of the larynx during respiration. Spontaneous resolution of symptoms is the rule, it usually occurs by the age of 2–5 years. Surgical intervention is indicated only in severe cases of laryngomalacia.AimThe aim of this study was to assess clinical presentation, management and prognosis of infants and children suffering from laryngomalacia presented to our department in the period of 5 years.MethodsThe medical sheath records of newborns and infants suffering of laryngomalacia were reviewed regarding demographic data, clinical presentation, diagnosis and management.ResultsFifty eight infant and child were included in the study. They were 33 males (57%) and 25 females (43%). Their age at presentation ranged from 2 to 13 months with mean age of 6.3 months. Diagnosis was done using laryngoscopy under general anesthesia with spontaneous breathing in 49 patients (85%) and by using flexible nasopharyngolaryngoscopy under topical anesthesia in 9 patients (15%). Conservative treatment was given for all cases in the form of diet modification, lansoprazole (7.5 mg once daily) and Domperidone (1 mg/kg/day). For mild cases, gradual improvement occurred within 1 to 3 months. For severe cases, surgical intervention was planned. Indications for surgical intervention were severe airway obstruction with attacks of cyanosis, feeding difficulties and aspiration, weight loss and failure to thrive.ConclusionLaryngomalacia is the most common congenital anomaly of the larynx. It usually presents within 2 weeks after birth. Diagnosis depends on visualization of the larynx during respiration. Conservative treatment is the rule. Surgical treatment is only indicated in 10% of cases.