Main content
Health and medicine
Laryngomalacia
Created by Ian Mannarino.
Want to join the conversation?
- At, does that mean that if a baby of about 5 months has severe Laryngomalacia, then they will need surgery? Which leads to the question, Can this surgery become fatal if failed? 4:41(2 votes)
Video transcript
- [Voiceover] Laryngomalacia
is congenital disorder, meaning it's a birth defect of the larynx. Now malacia means softness,
so translated directly, this means softness of the larynx. And technically you can think
that's what's going on here. Now over here I have a normal side view of what the larynx looks like. And over here I have a top
view of the normal larynx. So, in both these views
you can see the epiglottis, right here, the piece of
soft tissue that folds down, protecting the airway when you swallow, further down is the aryepiglottic folds, so, really these go all the way
down to where the larynx is, close to the voice box. And they're named the ary-,
or aryepiglottic folds because they're soft tissue
that really is in between the epiglottis and the
arytenoid cartilage. Now the arytenoid
cartilage, is around here, it's buried in the soft tissue, and it's really what the
vocal chords are connected to. Now, patients with
Laryngomalacia, or Laryngomalacia, have an airway that looks
a little more like this. Laryngomalacia is
softness of the cartilage, of not only the aryepiglottic
folds and the epiglottis, but more particularly, the cartilage around the voice box, around the larynx. The issue is that since
this cartilage is so soft, it leads to collapsing of the airway. So above the opening of the vocal chords, which is also known as
the glottic opening, so above the glottic opening,
this soft tissue can collapse and obstruct the airway. Now since it is congenital,
or again, in other words, a birth defect, it's
noted in young children around 4-8 months old. It can be noted earlier,
and it can be noted later, but 4-8 months is when it's most severe. So you can see, because
this tissue is so weak, when a patient tries to
pull air into their lungs, through the glottic opening, it snaps shut because of all the pressure around. So, the physiology is,
when you inhale air, you're creating a negative
pressure in the lungs. And that allows air to
be pulled into the lungs. But that negative pressure
acts like a vacuum, and sucks this soft tissue,
this softness, malacia, Laryngomalacia, it sucks this closed. So patients have difficulty breathing. And this leads to signs of low oxygen, such as cyanosis, which is
when the skin turns blue. Another common symptom is stridor, and stridor is a musical
noise on inspiration, because the airway is so narrow, when air rushes past the glottic opening, it makes a noise, a musical noise. Stridor is very similar to
air rushing through a window. If a window is partially open, and air rushes in, it'll
make a howling noise. Right, you've heard of
howling wind before. And so it's a similar concept
that produces stridor. Patients with Laryngomalacia
also experience gastro-esophageal reflux. Reflux from the stomach. This can be an issue,
because not only can the acid get into the lungs and cause damage, but can also further
cause damage to the larynx and the surrounding soft tissue, which further narrows the airway. So reflux can be a potential
complication in these patients. And along with difficulty
breathing, and reflux, a patient may have a difficult
time feeding as well. Because when they eat, it
makes it more difficult to breathe air in. So patients may experience
difficulty feeding, leading to poor weight
gain, and even weight loss. Now, diagnosis of
Laryngomalacia has to do with directly observing the airway tissue. In fact, I've drawn the
epiglottis curved, like this, because this is actually
a very typical sign of Laryngomalacia. It's called an omega sign,
because the soft tissue curves in a way that looks
like the Greek letter omega. So, omega sign, along with these symptoms, leads to the diagnosis of Laryngomalacia. Now treatment of this disorder
is actually very limited, but thankfully most of the
time, treatment is not needed. If the symptoms are mild, for example, if the patient only experiences
mild difficulty breathing when feeding, then
reassurance and follow-up with the patient may be the best solution. In fact, resolution of Laryngomalacia is usually around 18-20 months. However, if symptoms are very severe, then surgery should be pursued. And the surgery involves cutting down the aryepiglottic folds,
to open the airway up a little bit more.