A health condition, which is a type of voice box disorder in newborns, is called laryngomalacia. It negatively affects the tissues above their voice box, which causes them to fall over the airway. While the most common symptom of laryngomalacia is stridor, it may also cause other symptoms. Mild forms of this condition often go away within 1 to 2 years. Physicians often help manage the symptoms during this time.
In other words, laryngomalacia is a larynx abnormality that appears in newborns. It often happens when the tissues above the voice box are weak. Moreover, this condition is one of the most common causes of noisy breathing in babies. In most cases, this condition is not dangerous, but some babies may develop a severe form of laryngomalacia, which can cause breathing and feeding problems.
In general, laryngomalacia occurs commonly in infants, and about 50% of all newborns have it during the first weeks of life. In addition, this condition may also happen in adults, but it is less common.
Types of Laryngomalacia
Healthcare professionals have divided this condition into 3 categories based on the exact cause. These include:
- I – The first type of this condition happens when the mucous membranes of the voice box are too tight or too short.
- II – In such cases, the upper part of the voice box has excessive soft tissue.
- III – In such cases, it happens due to an underlying disorder (such as gastroesophageal reflux disease, also known as GERD).
Symptoms
The symptoms of laryngomalacia range among babies from mild to severe. While the main symptoms are noisy, loud, and squeaky breathing, it may also cause other symptoms. The noisy breathing often gets louder when the baby is crying, sleeping, or feeding. In more severe cases, laryngomalacia may also cause the following symptoms. These include:
- Aspiration (pulling food into the lungs)
- Apnea (long pauses in breathing)
- Dysphagia (swallowing problems)
- Inability to gain weight
- Cyanosis (a health condition in which the skin becomes bluish)
If any of the previous symptoms occur, immediately contact the baby’s pediatrician. Otherwise, it may lead to serious complications.
Causes and Risk Factors
Generally, physicians do not fully understand what exactly causes laryngomalacia, but they have some theories about why it happens. For example:
- GERD – When the acid reflux reaches the voice box, it causes swelling in that area. As a result, it leads to the worsening of any existing structural abnormalities.
- Structural abnormalities – Sometimes, the muscles or cartilage localized around the voice box may develop improperly during pregnancy.
- Neuromuscular disorders – These include conditions that negatively affect the vocal cord nerves and muscles.
While anyone can develop laryngomalacia, the following factors may increase their risk. Check some examples below:
- Sex – Males are slightly more prone to laryngomalacia compared to females.
- NICU (neonatal intensive care unit) admission
- Secondary airway lesions (such as tracheomalacia)
- Neurological or congenital disorders – For example, Pierre Robin sequence, Down syndrome, neuromuscular weakness, and others.
- Premature birth or low birth weight – These pregnancy complications could also play a role in laryngomalacia.
What Are The Potential Complications of Laryngomalacia?
Mild forms of this condition often do not cause any complications and go away without treatment, but in more severe cases, your baby may experience the following complications. Examples include:
- Feeding problems (it may also lead to inability to gain weight due to frequent vomiting, choking, or gagging during feeding)
- Trouble breathing – In more severe cases, obstruction of the airways may lead to severe retractions, chronic (long-term) noisy breathing, and other respiratory problems.
- Respiratory distress and apnea – These include prolonged pauses in breathing or obstructive sleep apnea that often require immediate treatment.
- Cyanosis – This complication may turn the color of the baby’s lips and face skin bluish.
- Aspiration – Sometimes, the food may enter the lungs and cause pneumonia and other breathing problems.
The previous list does not contain a full list of complications, but doctors may recommend some options to reduce the risk or even prevent them. Unfortunately, there is no way to prevent this condition because it occurs during pregnancy.
Diagnosis
The primary test used to diagnose this condition is nasopharyngolaryngoscopy (NPL). It is usually performed by an otolaryngologist (ENT). However, physicians may also perform other tests to determine the stage (extent) of the condition. Check some of them below:
- Airway fluoroscopy – This procedure involves X-rays and a contrast agent that helps get clearer images of different parts of the baby’s body. It can also be performed during a swallow study.
- Impedance probe – During this procedure, doctors will insert a small tube through the baby’s nose and into the esophagus to see whether the stomach produces too much acid as it reaches the voice box. Most of the time, babies who undergo this procedure will stay 1-2 days in the hospital.
- Microlaryngoscopy and bronchoscopy – These tests often involve a small and flexible tube with a lighted camera on the end that allows the doctors to examine the trachea and voice box. Commonly, they are performed under general anesthesia.
- Neck or chest X-rays – This is another imaging test used to check for structural abnormalities linked with noisy breathing.
Treatment
Usually, laryngomalacia is mild and goes away without treatment within a year or two. In any case, doctors may also recommend some home remedies that will help ease symptoms. For example:
Home Remedies
When babies have mild symptoms, doctors may recommend a thickened formula to make sure they get enough nutrients and elevating the head of their mattress to improve breathing problems.
In more severe cases, physicians may prescribe other treatment options. These include:
- Medicines – They often prescribe proton pump inhibitors (PPIs) or H2 blockers to reduce stomach acid production. Managing GERD symptoms may help prevent worsening of the swelling.
- Surgery – Doctors often recommend surgery to remove the weak and floppy tissue above the baby’s voice box. This type of surgery is called supraglottoplasty, and it is performed by an ENT surgeon.
Frequently Asked Questions
How long does it take to feel better after treatment?
Most of the time, anti-reflux medicines improve symptoms within 14 days, but the baby will need to take these medicines for a long time (sometimes for a few months). Furthermore, the baby’s breathing may sound worse for several days after surgery. It happens due to post-operative inflammation around the vocal cords.
When should I go to the ER?
If your baby experiences any of the following symptoms, immediately contact your healthcare provider. Check some examples below:
- Breathing stops for more than 10 seconds at a time
- Cyanosis
- Feeding problems
What worsens laryngomalacia?
The symptoms of this condition may worsen when your baby is lying on his/her back or has GERD. Do not hesitate to contact your doctor if you notice that the symptoms worsen or your baby experiences new symptoms. Ask your healthcare provider if you have additional questions.
