Laryngomalacia: Difference between revisions
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==Background== | ==Background== | ||
*Common cause of inspiratory [[stridor (peds)]] in infants and children | [[File:Cross section of a trachea and esophagus.png|thumb|Cross section of a trachea and esophagus anatomy.]] | ||
[[File:Blausen 0865 TracheaAnatomy.png|thumb|Tracheal anatomy.]] | |||
*Common cause of inspiratory [[stridor (peds)|stridor]] in infants and children | |||
*Characterized by collapse of supraglottic tissue during inspiration | |||
**Differs from [[tracheomalacia]] in that this pathology involves soft tissue rather than tracheal cartilage | |||
*Etiology not well-known, possible mechanisms include redundant neck tissue, neurologic causes | *Etiology not well-known, possible mechanisms include redundant neck tissue, neurologic causes | ||
*Typically presents as early as 2 years of life, resolves by 2 years of age<ref>Shah UK, Wetmore RF. Laryngomalacia: a proposed classification form. Int J Pediatr Otorhinolaryngol. 1998 Nov 15;46(1-2):21-6. doi: 10.1016/s0165-5876(98)00111-6. PMID: 10190701.</ref> | *Typically presents as early as 2 years of life, resolves by 2 years of age<ref>Shah UK, Wetmore RF. Laryngomalacia: a proposed classification form. Int J Pediatr Otorhinolaryngol. 1998 Nov 15;46(1-2):21-6. doi: 10.1016/s0165-5876(98)00111-6. PMID: 10190701.</ref> | ||
==Clinical Features== | ==Clinical Features== | ||
[[File:Laryngomalacia.jpg|thumb|Omega shaped epiglottis, seen in laryngomalacia.]] | |||
[[File:PMC4046316 fped-02-00051-g004.png|thumb|Left, severe laryngomalacia with epiglottic collapse with inspiration; Right, tight aryepiglottic folds and redundant arytenoid mucosa with inspiration.]] | |||
*Inspiratory [[stridor (peds)]], especially during sleep | *Inspiratory [[stridor (peds)]], especially during sleep | ||
*Snoring | *Snoring | ||
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==Differential Diagnosis== | ==Differential Diagnosis== | ||
{{Pediatric stridor DDX}} | |||
==Evaluation== | ==Evaluation== | ||
===Diagnosis=== | ===Diagnosis=== | ||
*Confirmed with fiberoptic laryngoscopy by pediatric ENT | |||
*Should also evaluate for other associated anomalies (e.g., esophageal atresia) | |||
==Management== | ==Management== | ||
*Mild (mild stridor with no other symptoms): | |||
**Frequent monitoring with PCP to ensure adequate weight gain | |||
*Moderate/severe: | |||
**Referral to ENT | |||
==Disposition== | ==Disposition== | ||
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==See Also== | ==See Also== | ||
*[[Tracheomalacia]] | |||
==External Links== | ==External Links== | ||
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==References== | ==References== | ||
<references/> | <references/> | ||
[[Category:ENT]] | |||
Latest revision as of 19:41, 17 January 2024
Background
- Common cause of inspiratory stridor in infants and children
- Characterized by collapse of supraglottic tissue during inspiration
- Differs from tracheomalacia in that this pathology involves soft tissue rather than tracheal cartilage
- Etiology not well-known, possible mechanisms include redundant neck tissue, neurologic causes
- Typically presents as early as 2 years of life, resolves by 2 years of age[1]
Clinical Features
- Inspiratory stridor (peds), especially during sleep
- Snoring
- Dysphagia
- Gastroesophageal reflux disease
Differential Diagnosis
Pediatric stridor
<6 Months Old
- Laryngotracheomalacia
- Accounts for 60%
- Usually exacerbated by viral URI
- Diagnosed with flexible fiberoptic laryngoscopy
- Vocal cord paralysis
- Stridor associated with feeding problems, hoarse voice, weak and/or changing cry
- May have cyanosis or apnea if bilateral (less common)
- Subglottic stenosis
- Congenital vs secondary to prolonged intubation in premies
- Airway hemangioma
- Usually regresses by age 5
- Associated with skin hemangiomas in beard distribution
- Vascular ring/sling
>6 Months Old
- Croup
- viral laryngotracheobronchitis
- 6 mo - 3 yr, peaks at 2 yrs
- Most severe on 3rd-4th day of illness
- Steeple sign not reliable- diagnose clinically
- Epiglottitis
- H flu type B
- Have higher suspicion in unvaccinated children
- Rapid onset sore throat, fever, drooling
- Difficult airway- call anesthesia/ ENT early
- H flu type B
- Bacterial tracheitis
- Rare but causes life-threatening obstruction
- Symptoms of croup + toxic-appearing = bacterial tracheitis
- Foreign body (sudden onset)
- Marked variation in quality or pattern of stridor
- Retropharyngeal abscess
- Fever, neck pain, dysphagia, muffled voice, drooling, neck stiffness/torticollis/extension
Evaluation
Diagnosis
- Confirmed with fiberoptic laryngoscopy by pediatric ENT
- Should also evaluate for other associated anomalies (e.g., esophageal atresia)
Management
- Mild (mild stridor with no other symptoms):
- Frequent monitoring with PCP to ensure adequate weight gain
- Moderate/severe:
- Referral to ENT
Disposition
See Also
External Links
References
- ↑ Shah UK, Wetmore RF. Laryngomalacia: a proposed classification form. Int J Pediatr Otorhinolaryngol. 1998 Nov 15;46(1-2):21-6. doi: 10.1016/s0165-5876(98)00111-6. PMID: 10190701.