A newborn baby's voice box (larynx) becomes afflicted with laryngomalacia, which occurs when the tissues above the vocal cords are floppy and collapse into the airway. Stridor occurs when the vocal cords are soft and floppy, resulting in noisy or high-pitched breathing. Stridor is most commonly caused by laryngomalacia, which usually resolves itself by one year of age. In some cases, however, medical treatment may be necessary to manage the symptoms and prevent complications.
Laryngomalacia is caused by a problem with the cartilage of the larynx during pregnancy. The following factors may increase the risk of laryngomalacia:
Smoking or exposure to tobacco smoke or other harmful substances during pregnancy
Infections in the newborn period
Family history of thyroid disease
Genetic mutations in the genes GDF6, GDF3, or MEOX1
Symptoms of laryngomalacia include stridor, which is often noticed at birth or within the first few weeks of life. Other symptoms may include:
Difficulty feeding or swallowing
Poor weight gain or failure to thrive
Frequent ear infections or hearing loss
Acid reflux or vomiting
Apnea (pauses in breathing) or cyanosis (bluish skin color)
Neck or chest retractions (pulling in of the skin when breathing)
The diagnosis of laryngomalacia can be determined by a physical examination, followed by a laryngoscopy, which is a procedure that involves inserting a thin, flexible tube with a camera and a light into the nose or mouth to view the larynx. The doctor can see the floppy tissues and how they affect the airway. To determine the severity of the condition and rule out other causes of stridor, the following tests can be performed:
X-rays, CT scans, or MRI scans of the chest and neck
Blood tests to check the levels of thyroid hormones, blood cells, and electrolytes
Urine tests to check the levels of sugar and protein
Sleep studies to monitor the breathing patterns and oxygen levels during sleep
Treatment for laryngomalacia depends on the severity of the symptoms and the presence of complications. Laryngomalacia is typically mild and does not require treatment, since it improves with time and growth. However, some treatment options may be considered, including:
Medications to treat acid reflux, inflammation, or infections
Feeding modifications, such as thickening the liquids, using a special nipple, or feeding more frequently and slowly
Surgery to remove or trim the excess tissues that block the airway. This is usually done by a procedure called supraglottoplasty, which is performed under general anesthesia and using a laser or a cold instrument. Surgery is reserved for severe cases that do not respond to other treatments or that cause life-threatening complications, such as apnea, cyanosis, or failure to thrive.
While laryngomalacia cannot be prevented, there are some steps that can be taken to reduce the risk of complications and improve the quality of life of babies with laryngomalacia.
Avoiding smoking or exposure to tobacco smoke or other harmful substances during and after pregnancy
Following the doctor’s recommendations for medications, feeding, or surgery
Having regular check-ups and tests to monitor the condition and the growth of the baby
Seeking support from family, friends, or professional counselors to cope with the emotional and physical challenges of living with laryngomalacia
