An Overview of Laryngomalacia

Laryngomalacia is a congenital condition which softens the tissues of the larynx—also known as the voice box—above the vocal cords. It is typically seen at birth or shortly after birth, with the average age of diagnosis being about 2 weeks old. This condition is the most common cause of loud breathing in infants.

It’s often seen in babies whose families have no history of the condition, and in 90 percent of cases, laryngomalacia resolves on its own when the infant is 18 to 20 months old. When the condition does not resolve, or in severe cases where an infant has trouble with breathing and eating, surgery or medication might be necessary.

In laryngomalacial, the tissues of the larynx are softened.

Causes

It is not known what causes laryngomalacia. It’s hypothesized that there might be a neurological or anatomical factor involved, but more research needs to be done. Gastroesophageal reflux might play a role in how severe the symptoms are.

Symptoms of laryngomalacia are caused by the cartilage over the larynx being floppy and collapsing during inhalation, which results in noisy breathing.

Signs and Symptoms

Symptoms of laryngomalacia might be noticeable immediately at birth, or it might become more noticeable as time goes on during those first couple weeks. The noisy breathing can often get worse before getting better, and this typically occurs between 4 and 8 months of age. Symptoms of the condition can include:

• Noisy/loud breathing, like a wheeze
• Trouble feeding/eating
• Poor weight gain
• Choking while eating
• Apnea
• Turning blue (also called cyanosis)
• Pulling in the neck and chest each time a breath is taken
• Apiration
• Reflux

Diagnosis

Taking note of the typical signs and symptoms of laryngomalacia is often the first step toward a diagnosis. When you go to the doctor, they will likely ask you about what you’ve observed, any health issues with your baby, and do an exam. They might recommend something called a nasopharyngolaryngoscopy (NPL), where a very thin tube with a tiny camera on the end is inserted into the baby’s nostril and goes to the part of the throat where the larynx is. This will give the doctor a better look at the voice box and tissues to see what is going on.

After an official diagnosis, your physician might recommend other tests to evaluate the extent of the condition, whether any other part of the airway might be affected, and to rule out any other condition.

Treatments

Mild signs and symptoms of laryngomalacia are not necessarily an immediate cause for concern or urgent treatment. Indications for surgical intervention are not firmly established. However, a 2016 retrospective study found that supraglottoplasty resulted in faster and more complete recovery than a wait-and-see approach.

Signs that surgery is necessary can include:

• Apneas that are life-threatening
• Failure to thrive/gain weight
• Any heart/lung issues that are present that affect the ability to get enough oxygen
• Significant episodes of cyanosis

When medication is warranted, the doctor might prescribe anti-reflux medicine. When your infant brings in her neck and chest when breathing, this can make reflux worse. Compounding that, if reflux is present, the acid from the reflux can cause swelling of the tissue above the vocal cords, making breathing worse and even noisier.

Surgery is done in severe instances of laryngomalacia, and the surgery of choice is called a supraglottoplasty. In this operation, the extra soft floppy tissue near the larynx is surgically removed under general anesthesia. This operation might need to be done more than once, and while it might not stop noisy breathing completely, it can reduce it and help ease breathing.

When to See a Doctor

Go to the hospital or call 911 immediately if your infant:

• Stops breathing for more than 10 seconds
• Develops a bluish tint around the lips while loudly breathing
• Pulls the neck or chest in without any relief after they are awakened or repositioned

A Word From Verywell

If your child was diagnosed with laryngomalacia, it’s understandable that you might be feeling a range of emotions. Hearing that your child has a medical condition can be scary—but this is treatable, and in most cases, your child will likely not even need medical intervention. Talk with your child’s doctors to learn more about what this means for your child, what you should be aware of, and what changes or symptoms you should look out for.