laryngomalacia, tracheomalacia

Some babies are born with or are soon noted to have abnormally noisy breathing. Especially on inspiration, the child makes a crowing or rattling sound that can be very frightening to the parents.

While there are other much more rare causes of noisy breathing (stridor) that occur, almost all of these are caused by congenital deformities or flabbiness of the epiglottis (the flap of tissue that closes off the windpipe when you swallow) and the area above the opening of the windpipe (trachea), and weakness of the walls of the windpipe (tracheomalacia). Inspiration causes partial collapse and loud vibration of the soft tissues around the airway; this produces the characteristic noisy breathing.

The noisy breathing can be intermittent and is usually worse when the baby lies on his or her back. The cry may be hoarse as well. While some infants merely have noisy breathing, others have much more severe symptoms such as crowing respirations and even difficulty breathing with retractions. Severe, chronic retractions can even lead to chest wall deformity. Other complications of laryngomalacia can include difficulty with nursing, resulting in undernutrition and poor weight gain. These cases may need surgical intervention, which can be done by laser removal of redundant tissue in the laryngeal area (supraglottoplasty) is available. In this procedure, excess floppy, obstructing tissue around the inlet of the larynx is removed and the condition corrected.

Laryngomalacia is usually diagnosed by direct laryngoscopy. This means that a specialist directly visualizes the airway while the child is briefly anesthetized. The trachea (windpipe) and bronchial tubes (larger airways) are often visualized at the same time (direct bronchoscopy) to check for other rarer conditions that can mimic laryngomalacia.

Sometimes the stridor seems to get slightly worse in the first few months of life, but gradually it lessens with the natural stiffening of the airway structures, and normally disappears around about one year of age. Most babies seem more comfortable or less noisy lying in a prone position (on the stomach).

Although laryngomalacia usually resolves for practical purposes by age 18 months, mild symptoms may persist a little longer. Some patients may develop mild stridor with respiratory infection, exertion, or crying throughout childhood.

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