laryngomalacia

Laryngomalacia is the most common cause of congenital stridor in infants, resulting from softening and inward collapse of the supraglottic tissues above the vocal cords during inspiration. Most cases are present in early life, often within the first weeks to months. The stridor is typically inspiratory and may worsen with feeding, agitation, crying, or when the infant is supine; it often improves with prone positioning or during sleep.

Pathophysiology is multifactorial. The leading theories include an omega-shaped epiglottis, redundant aryepiglottic folds, and delayed maturation of laryngeal cartilage, which together cause dynamic collapse of the supraglottic inlet during inspiration. The condition may be isolated or associated with other congenital anomalies or syndromes.

Diagnosis is usually clinical, based on history and flexible fiberoptic laryngoscopy or direct laryngoscopy showing inspiratory collapse of the supraglottic structures. Imaging is not routinely required. The differential diagnosis includes other causes of pediatric stridor such as laryngeal or vocal cord abnormalities and subglottic stenosis.

Management ranges from observation to medical and surgical interventions. Mild cases are typically managed with reassurance and monitoring; treatment of gastroesophageal reflux and nutritional support may help. Severe cases with significant airway obstruction or failure to thrive may require operative intervention, most commonly supraglottoplasty to widen the airway. Anesthesia and perioperative airway management are important considerations.

Prognosis is generally favorable, with most children improving or outgrowing symptoms by 12–18 months as tissues stiffen. A minority have persistent symptoms or associated conditions. Laryngomalacia remains the leading cause of inspiratory stridor in infancy.