Laryngomalacia is diagnosed by history and physical exam. There are a variety of symptoms that may be indicative of laryngomalacia, including:
- Inspiratory stridor (high-pitched noise while breathing in) that is often worse with crying, laying on back, feeding
- Cyanotic episodes (turning blue)
- Retractions (sucking in of chest/neck with each breath)
- Apneic episodes (stopping breathing)
- Coughing/choking with feeds
- Aspiration (inhalation of food into lungs)
- Slow feeding
- Poor weight gain/failure to thrive
Sometimes an endoscopic exam is also needed to aid in the diagnosis of laryngomalacia. Using a small, thin, flexible scope, the physician is able to assess the voice box, looking for floppiness of the larynx and signs of reflux.
Both medical and surgical treatment options are available for patients with laryngomalacia. For mild cases, no treatment is indicated, as this will likely resolve on its own. For moderate cases, most infants will do well with medical treatment of reflux alone using antireflux medications, such as omeprazole or lansoprazole.
Infants with more severe symptoms or those who do not improve despite medical treatment may require surgical intervention. The surgery for this disorder is known as a supraglottoplasty, and it is performed using traditional surgical instruments with or without a laser. While the noisy breathing may not complete resolve, the goal of the surgery is to allow for easier feeding and breathing. Overnight stay in the hospital following surgery is typically required to monitor for any problems with breathing following surgery.