Laryngomalacia / Floppy Larynx
What is the larynx?
Your child’s voice box is the larynx. The larynx serves important functions:
-It allows your child to breathe
-It ensures that when feeding things don't go down the wrong way
-It produces the voice
So although it is called the voice box, it actually has other functions as important as voice.
The larynx is a tube made of a number of rigid structures, called cartilage, which form part of your child’s airway.
What happens in laryngomalacia?
Laryngomalacia is a term used to describe a floppy larynx or voice box, where the larynx isn’t staying open during breathing as it should be. Instead, when the child breathes in, the larynx collapses.
When your child takes a breath in, you will hear high-pitched noisy squeaky breathing. This noisy breathing is called stridor. The noise happens when the larynx collapses and the breathing passages become partially blocked.
The stridor is often worsen when your child is upset, has a cold or lies on its back.
Laryngomalacia usually affects babies aged a few weeks or months. It is a very common condition.
For many babies, noise is the only thing that parents notice. But if laryngomalacia is severe, the baby can struggle to breathe, struggle to feed, and not gain weight as expected.
Photographs of the larynx with laryngomalacia. It is not possible to see "floppiness" as these are still pictures. Please have a look at the stridor page showing a normal looking larynx, then you will be able to appreciate how blocked and narrowed the airway is in these two pictures
Are there any other conditions that cause noisy breathing?
Stridor can be caused by a number of different things. Laryngomalacia is a common explanation, but a variety of other causes exist including vocal cord palsy and subglottic stenosis.
The following might suggest that the cause of stridor is something other than laryngomalacia:
-prematurity requiring Neonatal Intensive Care
-severe stridor noted immediately after birth
-husky voice
How will my child be assessed?
Have a look at the section on stridor and airway evaluation.
Treatment of laryngomalacia
Usually nothing is required! The majority of children grow out of laryngomalacia, so one option is to monitor how your child progresses. Usually it resolves by about 2 years of age.
Laryngomalacia is often associated with reflux of stomach acid, which can irritate the voice box. A medication can therefore be taken to reduce this reflux and improve breathing symptoms. Treatments to prevent acid reflux re also often used after any surgery.
If your child has significant breathing difficulty or is not growing well, they may need surgery. This is done with your child asleep under general anaesthetic. The surgeon will thoroughly examine the airway passages first, to confirm that laryngomalacia is the cause of breathing problems. Assuming it is, the surgeon will then operate to make the area of laryngomalacia less floppy. Surgery is done through the mouth, so there isn’t usually much to see. However, some children get bruising around the lips or gums or a loose tooth, occasionally there is bleeding, or infection, or worsening of breathing problems. Some children struggle to feed after surgery and occasionally milk can go down the wrong way; this is called aspiration, and may need help from a speech therapist, feeding modification, or even a temporary feeding tube inserted through the nose. Vast majority of the time, children’s breathing is a lot better after surgery, but rarely symptoms persist.
Section contributor
Quentin Bounduelle MRCS DOHNS
Core Surgery Doctor
