Laryngomalacia in the congenital disorder of the larynx characterized by partial/ complete collapse of the supraglottic structures on inspiration.
It is the most common cause of congenital stridor.
TYPES OR CLASSIFICATION OF LARYNGOMALACIA:
Type 1: Foreshortened or tight aryepiglottic fold
Type 2: Presence of redundant soft tissue in the supraglottis
Type 3: Cases caused by other etiologies e.g. underlying neuro-muscular disease.
The diagnosis of laryngomalacia (LM) can often be made on the basis of a typical clinical history and examination findings. This is then confirmed by flexible fibre-optic laryngoscopy at the time of consultation. In many patients, a rigid laryngobronchoscopy (performed under anaesthesia) is also carried out.
Videofluoroscopic swallowing studies or functional endoscopic evaluation of swallowing (FEES) testing is used to assess feeding problems to detect episodes of laryngeal penetration or aspiration.
Investigations to document GORD should also be performed. The diagnosis of GORD may be suggested by the clinical history or by laryngeal appearance on endoscopy. A rigid esophagoscopy with biopsies may be performed. Other options include 24 hour pH monitoring and/or barium swallow.
Polysomnography (PSG) sleep studies are conducted to determine whether there is associated obstructive sleep apnoea (OSA). This test can provide useful information, particularly in following the progress and making management decisions for complex patients with multiple medical problems. This may be particularly relevant in children who experience a poor outcome after supraglottoplasty. Sleep studies are not useful in the diagnosis of Laringomalacia but may assist in the ongoing management of these patients.
Radiological tests are not required in the diagnosis of Laringomalacia, although the dynamic supralaryngeal collapse may be seen on fluoroscopy. Airway fluoroscopy has been found to be highly specific in diagnosing Laringomalacia, tracheomalacia, and airway stenosis; however, its sensitivity is poor and, therefore, its role as a screening tool is uncertain. Chest X-Ray and lateral airway views may also provide evidence of synchronous airway pathology or aspiration. In patients with clinical findings suggestive of an underlying genetic syndrome (e.g., Down’s syndrome) associated with congenital heart disease, evaluation with ECG and echocardiogram should be performed.