Laryngomalacia

What is laryngomalacia?

Laryngomalacia is a type of voice box abnormality present in newborn babies. The condition occurs when tissues located above the voice box are floppy and fall back over the airway. Laryngomalacia is the most common cause of noisy breathing in babies. Laryngomalacia is congenital, meaning it is present at birth.

Laryngomalacia and tracheomalacia: What’s the difference?

Both laryngomalacia and tracheomalacia are conditions affecting the airway. While laryngomalacia refers to floppy tissues above the voice box, tracheomalacia is characterized by floppy or weak cartilage of the windpipe. Tracheomalacia is far less common — and usually more serious — than laryngomalacia.

Who does laryngomalacia affect?

Laryngomalacia primarily affects infants. Laryngomalacia in adults is very rare, but it can occur.

How common is laryngomalacia in babies?

This condition is extremely common in infants. Over half of all newborn babies have laryngomalacia during the first week of life, and even more develop it when they’re two to four weeks old.

What are the symptoms of laryngomalacia?

Babies with laryngomalacia may exhibit mild, moderate or severe symptoms. The most common sign of laryngomalacia is stridor (loud, squeaky noises that occur when your baby breathes in). Stridor symptoms often worsen over the first several months, but resolve themselves within one year. Even though stridor sounds concerning, most babies with laryngomalacia have no trouble breathing or feeding. In infants with mild laryngomalacia, breathing usually gets louder when lying down, sleeping, crying or feeding.

Though not as common, some babies may have severe laryngomalacia symptoms, which include:

• Loud, noisy breathing.
• Difficulty swallowing (dysphagia).
• Apnea (long pauses in breathing).
• Cyanosis (a condition that causes the skin to develop a bluish hue).
• Aspiration (pulling food into the lungs).
• Poor weight gain.
• GERD (chronic acid reflux).
• A tugging or “pulling in” at the neck or chest when breathing.

If your baby exhibits any of the symptoms listed above, call your healthcare provider right away.

What causes laryngomalacia?

An exact cause is unknown, but experts believe it has something to do with the way the voice box develops during fetal development. The muscles supporting the voice box may be too weak or relaxed. Additionally, GERD — which is common in babies with laryngomalacia — may make laryngomalacia symptoms worse.

How is laryngomalacia diagnosed?

Your healthcare provider will conduct an examination and ask you about your baby’s overall health. They may also perform a test called a nasopharyngolaryngoscopy (NPL), which uses a tiny camera to view your baby’s voice box.

If a laryngomalacia diagnosis is made, other tests may be necessary to determine the extent of the condition. These may include:

• Neck or chest X-rays: These imaging tests can tell your healthcare provider if your baby has any other abnormalities that may be contributing to noisy breathing.
• Microlaryngoscopy and bronchoscopy (ML&B): A lighted scope is used to examine your baby’s windpipe and voice box to see what is causing loud breathing. ML&B is performed under general anesthesia.
• Airway fluoroscopy: This procedure combines X-rays and a contrast agent (such as a dye) that illuminates problematic areas within the body.
• Impedance probe: During this procedure, a small tube is inserted through the nose and into the esophagus. A measuring device is then used to measure the amount of stomach acid that reaches the esophagus. Babies who undergo this procedure usually stay for at least one night in the hospital.

How is laryngomalacia treated?

In the majority of cases, laryngomalacia goes away on its own within one year. However, if your baby has severe laryngomalacia, medication or surgery may be necessary.

Laryngomalacia Medication

If GERD is contributing to your baby’s laryngomalacia, your healthcare provider may prescribe an anti-reflux medication. GERD can worsen swelling associated with laryngomalacia, so it’s important to keep reflux in check if it’s a contributing factor.

Laryngomalacia Surgery

Laryngomalacia surgery involves trimming the weak, floppy tissue above the voice box. This procedure is called supraglottoplasty and it’s performed under general anesthesia in an operating room.

How can I manage my baby’s symptoms?

Laryngomalacia management depends on your baby’s unique situation and the severity of their condition. For infants that have feeding difficulties, thickened feeding or positional feeding can help ease symptoms. Your healthcare provider may also recommend that you place your baby on their tummy to sleep. This helps keep the tissue from obstructing the airway. Ask you provider about specific ways to manage your baby’s laryngomalacia symptoms.

How long does it take to recover from laryngomalacia treatment?

Following laryngomalacia surgery, your baby may actually sound worse for a few days. This is normal, and it’s due to inflammation and swelling around the vocal cords. The noisy breathing should gradually improve, with full recovery taking about two weeks.

Can laryngomalacia be prevented?

Because laryngomalacia is a congenital condition, there is currently no known way to prevent it from occurring.

Is laryngomalacia life threatening?

Despite the associated noisy breathing, laryngomalacia is usually not dangerous, as most babies with the condition are still able to breathe. While most infants outgrow laryngomalacia, a few cases will require surgery to correct the issue.

Does laryngomalacia go away?

Yes. In most cases, laryngomalacia goes away on its own by the time an infant turns one year old.

When should I be concerned about laryngomalacia?

If your baby shows mild symptoms of laryngomalacia, such as noisy breathing, consider scheduling an appointment with your healthcare provider. They can examine your baby and make recommendations for home care and management. Call your provider if your baby develops sudden symptoms, or if they develop GERD.

When should I go to ER?

Head to the nearest emergency room if your baby:

• Stops breathing for more than 10 seconds at a time.
• Has a tugging or “pulling in” at the chest or neck, even after being awakened or repositioned.
• Turns blue around the lips.

A note from Cleveland Clinic

Laryngomalacia can be concerning, especially for new parents. In most cases, the condition isn’t dangerous, even though noisy breathing can be alarming. However, it’s always a good idea to schedule a consultation with your healthcare provider if you have any questions about your baby’s health.