Layngomalacia

• 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.

• 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.

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.

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

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.

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.

Ans. is ‘c’ i.e., Laryngomalacia

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.

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

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

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.

Ans. D: Laryngomalacia

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

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.

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.