The term "Laryngomalacia" literally translates to "Soft Larynx." The floppiness of the laryngeal tissues above the vocal cords causes it (the supraglottic larynx). The tissues above the vocal cords fall in towards the airway during inspiration (breathing in) and partially block the airway. This results in stridor (noisy breathing due to obstruction at the level of the voice box). Usually, the tissue folds the front and back of the voice box (aryepiglottic folds) are shortened. This causes the epiglottis to curl inward (become “omega-shaped”) and causes the tissue over the cartilage in the back of the voice box (arytenoids) to suck into the airway.

Laryngomalacia is the most common cause of noisy breathing in infants. More than half of infants have noisy breathing during the first week of life, and most develop this by 2-4 weeks of age. Rarely, laryngomalacia occurs in older children, or adults, particularly those with other medical problems.

Harsh noisy breathing on inspiration (noisy breathing/stridor). Stridor may be louder with exertion, feeding and crying. It may also be worse when lying on the back. It may be quieter when sleeping or resting quietly. Stridor will typically get louder over the first several months of life, as an infant gets stronger, then to improve over the first year of life. Signs of more severe laryngomalacia include difficulty feeding, increased effort in breathing, poor weight gain, pauses in the breathing, or frequent spitting up. It can be suspected or presumptively diagnosed by history and physical exam. Diagnosis can be confirmed with In-Office Laryngoscopy/Nasopharyngoscopy in an awake child.

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