Laryngomalacia

- [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.