Variations in the Grades of Laryngomalacia: Mild, Moderate, and Severe
Laryngomalacia: Understanding a Common Infant Condition
Laryngomalacia, a common condition in infants, is characterised by the soft, immature cartilages of the infant larynx collapsing upon inspiration, leading to noisy breathing (inspiratory stridor) [1][3]. This article aims to provide an overview of the causes, symptoms, and treatment of laryngomalacia.
The condition is primarily caused by the congenital immaturity and softness of the laryngeal structures. This immaturity and softness result in the collapse of the soft laryngeal tissues inward during inhalation, causing airway obstruction and characteristic noisy breathing [1][3].
Anatomical variations, such as shortened aryepiglottic folds or an overly large epiglottis, may contribute to this dynamic airway collapse [5]. Additionally, neuromuscular dysfunction affecting laryngeal tone or sensation could play a role, although the exact mechanisms remain unclear [4]. Comorbid conditions like gastroesophageal reflux disease (GERD) can exacerbate symptoms by irritating the larynx and worsening tissue swelling, thus increasing airway obstruction severity [5].
Severe laryngomalacia can cause recurrent cyanosis (blue hands and feet), sleep apnea, difficulty eating, and aspiration. Chronic hypoxia in severe laryngomalacia can lead to pulmonary hypertension and cor pulmonale if not managed [2].
Infants with severe laryngomalacia may require revision surgery or tracheostomy, particularly if comorbidities are present. Approximately 94% of patients with anatomic obstructions have symptom resolution with a low complication rate following supraglottoplasty [6].
Laryngomalacia symptoms begin within the first few weeks of life, peak at 6 to 8 months, and resolve by 12 to 24 months. Early diagnosis of laryngomalacia is crucial due to its potential impact on growth and development. Laryngomalacia is the most common cause of stridor in infants [1][3][5].
Relative indications for surgery in severe laryngomalacia include recurrent aspiration pneumonia, weight loss without overt failure to thrive, and feeding difficulties that do not respond to medical treatment. Severe laryngomalacia may be associated with absolute indications for surgery, including significant obstruction, pectus excavatum, cor pulmonale, pulmonary hypertension, and hypoxia [7].
In summary:
| Theory/Factor | Description | |---------------------------------|--------------------------------------------------------------------------------------------------| | Congenital immaturity | Soft, pliable laryngeal cartilage causes collapse of tissues during breathing | | Anatomical variations | Abnormal shapes/lengths of aryepiglottic folds, epiglottis contribute to airway obstruction | | Neuromuscular dysfunction | Possible decreased neural control of laryngeal tone causing floppy tissue | | Comorbidities (e.g., GERD) | Inflammation due to reflux worsens laryngeal swelling and obstruction severity |
References:
[1] Laryngomalacia. (2019, June 17). In StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK532965/
[2] Laryngomalacia. (2021, February 18). In UpToDate. Waltham (MA): UpToDate. Retrieved from https://www.uptodate.com/contents/laryngomalacia-in-infancy-clinical-features-and-diagnosis
[3] Laryngomalacia. (2021, May 24). In Merck Manual Professional Edition. Rahway (NJ): Merck Sharp & Dohme Corp. Retrieved from https://www.merckmanuals.com/professional/pediatrics/disorders-of-the-larynx-and-trachea/laryngomalacia
[4] Laryngomalacia. (2021, February 24). In Merck Manual Consumer Edition. Rahway (NJ): Merck Sharp & Dohme Corp. Retrieved from https://www.merckmanuals.com/home/ear-nose-and-throat-disorders/disorders-of-the-voice-box-larynx/laryngomalacia
[5] Laryngomalacia. (2021, May 14). In American Academy of Pediatrics. Elk Grove Village (IL): American Academy of Pediatrics. Retrieved from https://www.healthychildren.org/English/health-issues/conditions/ear-nose-throat/Pages/Laryngomalacia.aspx
[6] Laryngomalacia. (2021, February 16). In Medscape. Madrid (ES): WebMD, LLC. Retrieved from https://emedicine.medscape.com/article/1113215-overview
[7] Laryngomalacia. (2021, February 18). In American Family Physician. Leawood (KS): American Academy of Family Physicians. Retrieved from https://www.aafp.org/pubs/afp/articles/2019/0415/p619.html
