Home › Forums › Infant Reflux Information › Respiratory › Laryngomalacia – What is it?
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February 28, 2006 at 3:49 pm #2696
Anonymous
InactiveHere’s some excepts from: http://www.emedicine.com/PED/topic1280.htm
Laryngomalacia may affect the epiglottis, the arytenoid cartilages, or both. When the epiglottis is involved, it is often elongated and the walls fold in on themselves. The epiglottis in cross section resembles an omega, and the lesion has been referred to as an omega-shaped epiglottis. If the arytenoid cartilages are involved, they appear enlarged. In either case, the cartilage is floppy and at endoscopy is noted to prolapse over the larynx during inspiration. This inspiratory obstruction causes an inspiratory noise, which may be high-pitched sounds frequently heard in other causes of stridor, coarse sounds resembling nasal congestion, and low-pitched stertorous noises.
Laryngomalacia is the most common cause of chronic inspiratory noise in infants, no matter which type of noise is heard. Infants with laryngomalacia have a higher incidence of gastroesophageal reflux, presumably a result of the more negative intrathoracic pressures necessary to overcome the inspiratory obstruction. Conversely, children with significant reflux may have pathologic changes similar to laryngomalacia, especially enlargement and swelling of the arytenoid cartilages.
Occasional inflammatory changes are observed in the larynx, which is referred to as reflux laryngitis. Because the epiglottis is often involved, gravity makes the noise more prominent when the baby is supine.
In severe cases, when it may be associated with gastroesophageal reflux, feeding problems such as choking or gagging may occur.
Noise is often increased when the baby is supine, during crying or agitation, during upper respiratory infection episodes, and in some cases, during and after feeds.February 28, 2006 at 3:49 pm #2698Inactivelaryngeal web
congenital anomaly consisting of mucous membrane-covered connective tissue between the vocal cords located ventrally and extending dorsally for varying distances; it causes airway obstruction and hoarse cry in the newborn.laryngeal stenosis
narrowing or stricture of any or all areas of the larynx; may be congenital or acquired.Laryngeal Cleft: Laryngeal clefts are a rare disorder where there is an abnormal communication between the trachea and esophagus. There may be a minor cleft just down to the vocal cords, or there can be a more major cleft connecting the trachea to the esophagus for the whole length of the trachea.
Laryngeal clefts
often present with vague symptoms of choking, noisy breathing, and frequent respiratory infections. This is due to varying degrees of aspiration, and if left untreated the lungs risk being permanently damaged. Laryngeal clefts are difficult to diagnose. Occasionally very small clefts can be fixed endoscopically but the vast majority of clefts will need to have an open surgery to be repaired. Children with laryngeal clefts also often have gastroesophageal reflux disease, and a few children will also have a tracheoesophageal fistula. Some syndromes, such as Opitz-Friaz, are more prone to having laryngeal clefts.Treatment for Laryngomalacia
In more than 99% of cases, the only treatment necessary is time. The lesion improves gradually, and noises are gone by 2 years of age in virtually all infants. The noise steadily increases over the first 6 months as inspiratory airflow increases with age. Following this increase, a plateau often occurs with a subsequent gradual disappearance of the noise. In some cases, the signs and symptoms dissipate, but the pathology may persist into childhood and adulthood. In those cases, symptoms or signs may recur with exercise or sometimes with viral infections.
If the baby has more noise and is uncomfortable when asleep, these babies may sleep prone, although one must then be careful to avoid soft bedding, pillows, and blankets.February 28, 2006 at 4:54 pm #2705InactiveFrom: http://www.utmb.edu/otoref/Grnds/Pedi-larynx-021120/Pedi-lar ynx-021120.htm
A history of noisy breathing and difficulty feeding should lead to suspicion of airway problems.
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It seems so obvious in hindsight. It never occurred to me that it wasn’t Logan’s esophagus that was causing the difficulty in feeding, but an immature Larnyx. That makes the whole ‘keeping him upright during feedings’ make a whole lot more sense.February 28, 2006 at 10:26 pm #2724InactiveMarsha, thankyou for all the valuable information. I really feel like I have been left in the dark about our daughters condition. If I hear “oh, that’s just a little stidor” again, I will loose it! I finally met with an ent that took me seriously, and actually scopes her periodically, especially when we are having bad episodes, to make sure the inflamed tissue is not causing servere breathing difficulties. I also finally found a gi that explained that laryngomalcia and reflux coexist alot. He drew a picture and told me about the pressure when they try to take a breath, and how it acts like a vaccum causing the stomach to reflux its contents. Hopefully we are at out peak right now and things will get better soon! Thanks again for all the info, I’m going to the sites tonight to read up on it some more. Sarah
October 6, 2006 at 9:41 pm #15102Inactivebump
November 30, 2006 at 9:43 am #19297InactiveMy 2-1/2 mo. son was diagnosed with laryngomalcia and the doctors want to do a scope on him – just to make sure – to rule anything else out. Anyway, what are your thoughts on the scope – it scares me – with the anestetic and all. I know what you mean Sarah, the doctors act like it isn’t a big deal – but to mom’s it is! Thanks!
November 30, 2006 at 7:58 pm #19343InactiveWhat kind of a scope Mary? What the pediatric ent dr. did was actually an in office procedure and the baby was awake. It was just a little camera that goes in the nose and down the back of the throat. Baby sits on your lap and you can actually watch the video of it happening in front of you. It was helpful to me because I could see the extent of the irritation. She was moderate, with some of the inflamed tissue flopping over the airway. Baby wasn’t too happy, it wasn’t painful, just irritated an already tempermental baby. Tomorrow she is going to get her adenoids out because of all the extra tissue. She’s outgrown it alot (stridor and blue spells) but she still gets hoarse and has alot of congestion. Hopefully it will releive her symptoms.
Do you have a ped ent? The periodic camera checks were the only thing that got me through it. YOu will find that sometimes his stidor sound so horrible when the reflux really irritates it. It helps to postition his differetly especially at night so he isn’t gasping for air and waking up. We used a sling/wedge combo and she was on her belly. She still can’t sleep on her back without snoring and waking up from gasping. Maybe it will change tomorrow!
Ryann had the scope at only 8 months old with the anestheia and came out fine. I did ask for biopsies too. I wanted to rule out other things as well. Best of luck, I know it is scarey!
November 30, 2006 at 8:24 pm #19344InactiveThanks Sarah! It is a bronchoscopy which they give some type of anestetic (versed sp?) down the nose and puts him in a twilight sleep that he won’t be able to feel or remember (but again he is only 2 mo – so it isn’t like he will anyway). And then some gel on the scope to numb anything that comes in contact with it. We went to a children’s pulmonary center to a doctor there. He was great but still not sure. But I was thinking like you – – I would really know for sure.
I will say a prayer for Ryann tonight – good luck tomorrow. Thank you again for your thoughts and advice.
July 15, 2007 at 5:52 pm #39285Inactivemy son is 3 years old and was diagnosed with laryngomalacia at 4 weeks old. he had failure to thrive and had to have bronchoscopy at 7 months. he had a general aneasthetic. it was scary but everything was fine. the doctors told me he wouldnt speak for a few days but within hours of coming round from ga i couldnt stop him talking. he has bad reflux and needs to be monitored. he still has the stridor noise and is reletivly small. he still wear 12/18 months clothes, he is such a happy little boy. dont worry to much. i know its scary to hear and doctors have no sensetivity when it comes to their job. it is your child after all, but your child will be fine. the internet can make it sound scary but only 1 % of kids with it have it severe enough to require surgery. hope your little one is ok with the scope
September 25, 2008 at 2:29 pm #57106Inactivehello all,
This must be a very disturbing issue at times of flare ups.I wondered if any of you have tried using any air filter products, to rule out dust and so on? I highly recommend this site to learn more about them or whatever you need. I wish they had been available when I was a baby, I could not breathe well for at least 6 weeks!
May 11, 2010 at 7:09 am #66323InactiveLaryngomalacia is the most frequent cause of stridor or noisy breathing
in infants.It occurs as a result of a floppy portion of the larynx that
has not yet developed the strength to provide rigid support of the
airway.
May 1, 2011 at 10:29 pm #68318InactiveMy son was diagnosised at 8 weeks old. This was the 2nd time he had pneumonia since birth when they found this. We were sent to a bigger hospital and this is when they found out he was aspirating and had severe silent reflux.
They did a scope on him many times without any anesthetic,, it is very hard to watch your child go through that. But once they did a fundalication and controled the acid reflux the noise and laryngomalacia has calmed down in severity.
He is 5 months old now and barely has any noise. He also has a g button. The NG tube made this problem worse and it caused more respiratory issues.April 23, 2016 at 7:22 am #137983Inactivegfhgfhg
April 23, 2016 at 7:22 am #137984Inactiveetryt
April 23, 2016 at 7:22 am #137985Inactiveertryt
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