Congenital laryngomalacia

Congenital laryngomalacia, also known as congenital laryngeal stridor, is the most common congenital anomaly of the larynx (voice box) and the most frequent cause of stridor (noisy breathing) in newborns and infants. The condition is characterized by an abnormally soft and floppy supraglottic laryngeal tissue — particularly the epiglottis, aryepiglottic folds, and arytenoid cartilages — which collapse inward during inspiration, partially obstructing the airway. This results in the hallmark symptom of inspiratory stridor, which is typically high-pitched and worsens with feeding, crying, agitation, or when the infant is placed in a supine position. The condition primarily affects the upper airway and respiratory system, though secondary effects on feeding and growth can occur. Key clinical features include intermittent inspiratory stridor that usually appears within the first two weeks of life, feeding difficulties, gastroesophageal reflux, and in more severe cases, failure to thrive, obstructive apnea, cyanotic episodes, and pectus excavatum due to chronic increased respiratory effort. Diagnosis is confirmed by flexible laryngoscopy, which reveals the characteristic collapse of supraglottic structures during inspiration. The majority of cases (approximately 90%) are mild to moderate and resolve spontaneously by 12 to 24 months of age as the laryngeal cartilage matures and stiffens. Conservative management includes upright positioning during and after feeds, anti-reflux measures, and close monitoring of growth and respiratory status. For the approximately 10% of infants with severe laryngomalacia — characterized by significant feeding difficulties, failure to thrive, oxygen desaturation, or obstructive apnea — surgical intervention with supraglottoplasty is the standard treatment. This procedure involves trimming redundant supraglottic tissue and has a high success rate. The exact etiology remains incompletely understood, though neuromuscular immaturity, anatomical factors, and gastroesophageal reflux disease are thought to play contributing roles.

Common questions about Congenital laryngomalacia