Layngomalacia

Layngomalacia

Q. 1

Omega shaped epiglottis is seen in ____________

 A

Laryngomalacia

 B

Epiglottitis

 C

Tuberculosis

 D

Carcinoma of epiglottis

Q. 1

Omega shaped epiglottis is seen in ____________

 A

Laryngomalacia

 B

Epiglottitis

 C

Tuberculosis

 D

Carcinoma of epiglottis

Ans. A

Explanation:

 

  • In laryngomalacia direct laryngoscopy shows elongated epiglottis, curled upon itself (omega–shaped), floppy aryepiglottic folds and prominent arytenoids.
  • Pediatric Epiglottis is omega–shaped and arytenoids relatively large covering significant portion of the posterior glottis.

Q. 2

A 3 month old child presents with intermittent stridor. Most likely cause is:

 A

Laryngotracheobronchitis

 B

Laryngomalacia

 C

Respiratory obstruction

 D

Epiglottitis

Q. 2

A 3 month old child presents with intermittent stridor. Most likely cause is:

 A

Laryngotracheobronchitis

 B

Laryngomalacia

 C

Respiratory obstruction

 D

Epiglottitis

Ans. B

Explanation:

Q. 3

Which of the following is the commonest cause of stridor in a newborn who born at term?

 A

Laryngomalacia

 B

Foreign body

 C

Meconium aspiration

 D

Recurrent laryngeal nerve palsy due to birth

Q. 3

Which of the following is the commonest cause of stridor in a newborn who born at term?

 A

Laryngomalacia

 B

Foreign body

 C

Meconium aspiration

 D

Recurrent laryngeal nerve palsy due to birth

Ans. A

Explanation:

Laryngomalacia is the most common cause of stridor in infants, and is also the most common congenital laryngeal abnormality, accounting for approximately 60% of cases. Stridor occurs as a result of prolapse of the supraglottic structures into the laryngeal inlet on inspiration. 
 
The epiglottis is classically described as being omega shaped and folded in upon itself so that the lateral margins lie close to each other. The aryepiglottic folds are tall, foreshortened, and thin, and the arytenoids are large with redundant mucosa.
 
Ref: Yates P.D. (2012). Chapter 33. Stridor in Children. In A.K. Lalwani (Ed), CURRENT Diagnosis & Treatment in Otolaryngology—Head & Neck Surgery, 3e.

Q. 4

A newborn is found to have stridor. What is the the commonest cause of stridor in a newborn?

 A

Laryngomalacia

 B

Foreign body

 C

Meconium aspiration

 D

Recurrent laryngeal nerve palsy due to birth

Q. 4

A newborn is found to have stridor. What is the the commonest cause of stridor in a newborn?

 A

Laryngomalacia

 B

Foreign body

 C

Meconium aspiration

 D

Recurrent laryngeal nerve palsy due to birth

Ans. A

Explanation:

Laryngomalacia is the most common cause of stridor in infants, and is also the most common congenital laryngeal abnormality, accounting for approximately 60% of cases.
Stridor occurs as a result of prolapse of the supraglottic structures into the laryngeal inlet on inspiration.
 
Also know:
 
Stridor is generally of laryngeal or tracheal origin.
As a general rule, inspiratory stridor originates from the supraglottis and glottis, expiratory stridor from the trachea, and biphasic stridor from the subglottis. 
 
Ref: Yates P.D. (2012). Chapter 33. Stridor in Children. In A.K. Lalwani (Ed), CURRENT Diagnosis & Treatment in Otolaryngology—Head & Neck Surgery, 3e.

Q. 5

What is the COMMONEST cause of stridor in a newborn?

 A

Laryngomalacia

 B

Foreign body

 C

Meconium aspiration

 D

Recurrent laryngeal nerve palsy due to birth

Q. 5

What is the COMMONEST cause of stridor in a newborn?

 A

Laryngomalacia

 B

Foreign body

 C

Meconium aspiration

 D

Recurrent laryngeal nerve palsy due to birth

Ans. A

Explanation:

Laryngomalacia is the most common cause of stridor in neonates.
Stridor occurs within the first 2-4 weeks of life.
In this case, stridor becomes worse with crying and agitation and is relieved by lying in the prone position. 

 

 

 

Vocal cord paralysis is the second most common cause of vocal cord paralysis. 

 

  • Stridor is primarily inspiratory in supraglottic disorders such as laryngomalacia.
  • It is biphasic or inspiratory and expiratory in glottic and subglottic disorders such as vocal cord disease, subglottic stenosis.
  • It is expiratory in tracheal disease such as tracheomalacia.

 

Ref: Pediatric Emergency Medicine  By Steven G. Rothrock PAGE 68.

 


Q. 6

What is the treatment of choice in a newborn presented with stridor due to laryngomalacia?

 A

No treatment

 B

Immediate surgery

 C

Steroids

 D

Surgery after 2 years

Q. 6

What is the treatment of choice in a newborn presented with stridor due to laryngomalacia?

 A

No treatment

 B

Immediate surgery

 C

Steroids

 D

Surgery after 2 years

Ans. A

Explanation:

In most patients, laryngomalacia is a self-limiting condition that does not result in any harm to the patient; therefore, observation is all that is required. In the most severe cases of laryngomalacia, which is encountered in a small percentage of patients, a temporary tracheotomy. The main indications for surgery are severe stridor, apnea, failure to thrive, pulmonary hypertension, and cor pulmonale.

 

 

 

Ref: Yates P.D. (2012). Chapter 33. Stridor in Children. In A.K. Lalwani (Ed), CURRENT Diagnosis & Treatment in Otolaryngology—Head & Neck Surgery, 3e. 

 


Q. 7

A 3 month old child presents with intermittent stridor. Most likely cause is:

 A

Laryngotracheobronchitis

 B

Laryngomalacia

 C

Respiratory obstruction

 D

Foreign body aspiraton

Q. 7

A 3 month old child presents with intermittent stridor. Most likely cause is:

 A

Laryngotracheobronchitis

 B

Laryngomalacia

 C

Respiratory obstruction

 D

Foreign body aspiraton

Ans. B

Explanation:

Q. 8

Most common cause of stridor in infants is:

 A

Laryngomalacia

 B

Laryngeal cysts

 C

Vocal cord polyp

 D

None of the above

Q. 8

Most common cause of stridor in infants is:

 A

Laryngomalacia

 B

Laryngeal cysts

 C

Vocal cord polyp

 D

None of the above

Ans. A

Explanation:

Laryngomalacia is the most common cause of stridor in infants and is also the most common congenital laryngeal abnormality, accounting for approximately 60% of cases.


Q. 9

Recognised cause of stridor in newborn-

 A

Cystic hygroma

 B

A Vascular ring

 C

Laryngomalacia

 D

All are true

Q. 9

Recognised cause of stridor in newborn-

 A

Cystic hygroma

 B

A Vascular ring

 C

Laryngomalacia

 D

All are true

Ans. D

Explanation:

Ans. is ‘d’ i.e., All of the above

Stridor

o Stridor refers to the physical finding of excessively noisy breathing and is general due to airway obstruction. Causes of Stridor in a child

Infections                                                                  Congenital                                                 Neoplasms

o Croup (laryngotracheobronchitis)              o Laryngomalacia                              o Subglottic hemangioma

o Epiglotitis                                              o Vocal cord palsy                              o Laryngeal papillomas

o Bacterial tracheitis                                  o Subglottic stenosis

o Retropharyngeal abscess                        o Vascular ring

o Saccular cyst

o Cystic hygroma, when it occurs in larynx then it can cause respiratory tract obustruction


Q. 10

Most common cause of stridor in infant and young children –

 A

Abductor palsy

 B

Croup

 C

Laryngomalacia

 D

Epiglottitis

Q. 10

Most common cause of stridor in infant and young children –

 A

Abductor palsy

 B

Croup

 C

Laryngomalacia

 D

Epiglottitis

Ans. C

Explanation:

Ans. is ‘c’ i.e., Laryngomalacia

Laryngomalacia is the most common congenital laryngeal anomaly.

o It is the most common cause of stridor in infants and children.


Q. 11

A 3 month old child presents with intermittent stridor. Most likely cause is –

 A

Laryngotracheobronchitis

 B

Laryngomalacia

 C

Respiratory obstruction

 D

Foreign body aspiration

Q. 11

A 3 month old child presents with intermittent stridor. Most likely cause is –

 A

Laryngotracheobronchitis

 B

Laryngomalacia

 C

Respiratory obstruction

 D

Foreign body aspiration

Ans. B

Explanation:

Ans. is ‘b’ i.e., Laryngomalacia

Larvngomalacia

o Laryngomalacia is the most common congenital laryngeal anomaly.

o It is the most common cause of stridor in infants and children.

  • Symptoms appear in the first 2 weeks of life and increase in severity for upto 6 months.
  • Typical presentation is inspiratory stridor which is exacerbated by any exertion (crying, agitation, feeding), supine position, and viral infection of URT.

Stridor is due to partial collapse of a flaccid supraglottic airway during inspiration.


Q. 12

Most common cause of stridor shortly after  birth –

 A

Laryngeal papilloma

 B

Laryngeal web

 C

Laryngomalacia

 D

Vocal cord palsy

Q. 12

Most common cause of stridor shortly after  birth –

 A

Laryngeal papilloma

 B

Laryngeal web

 C

Laryngomalacia

 D

Vocal cord palsy

Ans. C

Explanation:

Ans. is ‘c’ i.e., Laryngomalacia


Q. 13

A 2-month old infant has had inspiratory stridor since the first month of life, but has been otherwise well. Physical examination is unremarkable except for moderate inspiratory stridor and retractions which are worse when the infant is supine or agitated and better when he is prone and quiet. The most likely cause of these findings is –

 A

Reactive airway disease

 B

Laryngomalacia

 C

Viral croup

 D

An aspirated foreign body

Q. 13

A 2-month old infant has had inspiratory stridor since the first month of life, but has been otherwise well. Physical examination is unremarkable except for moderate inspiratory stridor and retractions which are worse when the infant is supine or agitated and better when he is prone and quiet. The most likely cause of these findings is –

 A

Reactive airway disease

 B

Laryngomalacia

 C

Viral croup

 D

An aspirated foreign body

Ans. B

Explanation:

Ans. is ‘b’ i.e., Laryngomalacia

  • Most common cause of inspiratory stridor in an infant is laryngomalacia.
  • Stridor is exacerbased on agitation, supine position and viral infection.

Q. 14

Most common congenital anomaly of larynx:

 A

Laryngeal web

 B

Laryngomalacia

 C

Laryngeal stenosis

 D

Vocal and palsy

Q. 14

Most common congenital anomaly of larynx:

 A

Laryngeal web

 B

Laryngomalacia

 C

Laryngeal stenosis

 D

Vocal and palsy

Ans. B

Explanation:

Q. 15

Regarding laryngomalacia:

 A

Most common cause of stridor in newborn

 B

Omega-shaped epiglottis

 C

Inspiratory stridor

 D

All

Q. 15

Regarding laryngomalacia:

 A

Most common cause of stridor in newborn

 B

Omega-shaped epiglottis

 C

Inspiratory stridor

 D

All

Ans. D

Explanation:

Q. 16

Which is not true about laryngomalacia?

 A

Omega-shaped epiglottis

 B

Stridor increases on crying, but decreases on placing the child in prone position

 C

Most common congenital anomaly of the larynx

 D

Surgical management of the airway by tracheostomy is the preferred initial treatment

Q. 16

Which is not true about laryngomalacia?

 A

Omega-shaped epiglottis

 B

Stridor increases on crying, but decreases on placing the child in prone position

 C

Most common congenital anomaly of the larynx

 D

Surgical management of the airway by tracheostomy is the preferred initial treatment

Ans. D

Explanation:

 

Laryngomalacia

  • It is the M/C congenital anomaly of the larynx
  • It is the M/C condition causing inspiratory stridor afterbirth.
  • The stridor worsens during sleep and when baby is in supine position (not in prone position). Rather when the child is placed in prone position it is relieved.
  • On laryngoscopy – Epiglottis is omega shaped and aryepiglottis folds are floppy.

Treatment

Conservative Management



Q. 17

About laryngomalacia, all are true except:

 A

MC neonatal respiratory lesion

 B

Decreased symptoms during prone position

 C

Self-limiting by 2-3 years of age

 D

Omega-shaped epiglottis seen

Q. 17

About laryngomalacia, all are true except:

 A

MC neonatal respiratory lesion

 B

Decreased symptoms during prone position

 C

Self-limiting by 2-3 years of age

 D

Omega-shaped epiglottis seen

Ans. B

Explanation:

Q. 18

Most common mode of treatment for laryngomalacia is: 

 A

Reassurance

 B

Medical

 C

Surgery

 D

Wait and watch

Q. 18

Most common mode of treatment for laryngomalacia is: 

 A

Reassurance

 B

Medical

 C

Surgery

 D

Wait and watch

Ans. A

Explanation:

 

In most patients laryngomalacia is a self-limiting condition.

Treatment of laryngomalacia is reassurance to the parents and early antibiotic therapy for upper respiratory tract infections. Tracheostomy is required only in severe respiratory obstruction.

Surgical intervention (supraglottoplasty i.e. reduction of redundant laryngeal mucosa) is indicated for 10% of patients. Main indica­tions for surgery are:

    • Severe stridor
    • Apnea
    • Failure to thrive
    • Pulmonary hypertension
    • Cor pulmonale



Q. 19

MC cause of intermittent stridor in a 10-day-old child shortly after birth is:

 A

Laryngomalacia

 B

Foreign body

 C

Vocal nodule

 D

Hypertrophy of turbinate

Q. 19

MC cause of intermittent stridor in a 10-day-old child shortly after birth is:

 A

Laryngomalacia

 B

Foreign body

 C

Vocal nodule

 D

Hypertrophy of turbinate

Ans. A

Explanation:

 

Laryngomalacia is the most common cause of inspiratory stridor in neonates.

The stridor in case of laryngomalacia is not constantly present, rather it is intermittent. So laryngomalacia is also the M/C cause of intermittent stridor in neonates.


Q. 20

Causes of congenital laryngeal stridor is/are:

 A

Laryngomalacia

 B

Laryngeal papillomatosis

 C

Subglottic papilloma

 D

All

Q. 20

Causes of congenital laryngeal stridor is/are:

 A

Laryngomalacia

 B

Laryngeal papillomatosis

 C

Subglottic papilloma

 D

All

Ans. A

Explanation:

Q. 21

Stridor in an infant is most commonly due to:

March 2010

 A

Diphtheria

 B

Acute epiglottitis

 C

Foreign body aspiration

 D

Laryngomalacia

Q. 21

Stridor in an infant is most commonly due to:

March 2010

 A

Diphtheria

 B

Acute epiglottitis

 C

Foreign body aspiration

 D

Laryngomalacia

Ans. D

Explanation:

Ans. D: Laryngomalacia

Laryngomalacia is the most common cause of inspiratory stridor in the neonatal period and early infancy and accounts for up to 75% of all cases of stridor.

Stridor may be exacerbated by crying or feeding.

Placing the patient in a prone position with the head up improves the stridor; supine position worsens the stridor. Laryngomalacia is usually benign and self-limiting and improves as the child reaches age 1 year.

If significant obstruction or lack of weight gain is present, surgical correction or supraglottoplasty may be considered if tight mucosal bands are present holding the epiglottis close to the true vocal cords or redundant mucosa is observed overlying the arytenoids.s


Q. 22

Following is true about laryngomalacia except ‑

 A

Omega shaped epiglottis

 B

Reassuarance of the patient is the treatment of choice

 C

Condition is first noticed in the first few weeks of life

 D

Expiratory stridor

Q. 22

Following is true about laryngomalacia except ‑

 A

Omega shaped epiglottis

 B

Reassuarance of the patient is the treatment of choice

 C

Condition is first noticed in the first few weeks of life

 D

Expiratory stridor

Ans. D

Explanation:

Ans. is ‘d’ i.e., Expiratory stridor

Laryngomalacia

  • It is the most common congenital abnormality of the larynx. Laryngomalacia is the most frequent cause of stridor or noisy breathing in infants. It occurs as a result of a floppy portion of the larynx (in supraglottic larynx) that has not yet developed the strength to provide rigid support to the airway. During inspiration negative pressure is created through larynx, which results in a collapse of these structures into the airway and a narrower breathing passage. Partial obstruction is the source of the noise with breathing (stridor), and sometimes cyanosis.
  • The hallmark sign includes intermittent stridor mostly in inspiration. It is usually more prominent when the infant is lying on his/her back (supine position, crying, feeding, excited or has a cold. Stridor gets relieved on placing the patient in prone position. This is usually first noticed in the first few weeks of life.
  • It may worsen over the first few months and become louder. This is because as the baby grows, inspiratory force is greater, which causes greater collapse of the laryngeal structures into the airway. This is usually worst at 3-6 months and then gradually improves as the rigidity of the cartilage improves.
  • Most children are symptom free by 1 to 2 years.
  • Sometimes, cyanosis may occur.
  • Direct laryngoscopy shows :-
  • Omega shaped epiglottis, i.e. elongated and curled on itself.
  • Floopy, tall, foreshortened and thin aryepiglottic folds.
  • Prominent arytenoids.
  • In most patients laryngomalacia is a self limiting condition. Treatment of laryngomalacia is reassurance to the parents and early antibiotic therapy for upper respiratory tract infections.

Q. 23

The shape of the epiglottis as shown in the image is seen in cases of ? 

 A

Laryngomalacia.

 B

Tuberculosis.


 C

Carcinoma of epiglottis.

 D

None of the above.

Q. 23

The shape of the epiglottis as shown in the image is seen in cases of ? 

 A

Laryngomalacia.

 B

Tuberculosis.


 C

Carcinoma of epiglottis.

 D

None of the above.

Ans. A

Explanation:

Ans;A.) Laryngomalacia

Omega shaped epiglottis as seen in the image, seen in cases of Laryngomalacia.

Laryngomalacia, shown in the image, is a congenital abnormality of the laryngeal cartilage. 

Laryngomalacia: The epiglottis is small and curled on itself (omega-shaped). Approximation of the posterior edges of the epiglottis contributes to the inspiratory obstruction.

  • In laryngomalacia direct laryngoscopy shows elongated epiglottis, curled upon itself (omega–shaped), floppy aryepiglottic folds and prominent arytenoids.
  • Pediatric Epiglottis is omega–shaped and arytenoids relatively large covering significant portion of the posterior glottis.




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