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Stridor and Laryngomalacia


Stridor

Stridor  is the sound made by turbulent air flow through a narrowed part of the respiratory tract. The sound usually comes from the larynx (voice box) or trachea (windpipe) and is a sign of airway obstruction in a child.

The larynx works as:

  • A passage for breathing
  • An organ of communication
  • A protective valve to prevent foreign objects, including food and water, from entering the lungs

Stridor can be caused by:

  • Congenital anomalies of the larynx, trachea and bronchial tree
  • Infectious conditions of the respiratory tract
  • Vocal cord paralysis
  • Trauma
  • Neoplasms (tumors) of the airway

Laryngomalacia

Laryngomalacia is the most frequent cause of stridor in infants (50% to 75%). It is a result of "floppy" structures and tissues that collapse into the airway. A low-pitched or squeaky intermittent inspiratory sound, which gets louder when the child is laying on its back, crying or feeding, is the hallmark of laryngomalacia. The child's cry may also be hoarse. 
Side effects of this disorder can include difficulty sucking/nursing and poor weight gain. In severe cases, there can be significant difficulty with breathing.

Stridor, or noisy breathing, is usually noticed in the first few weeks of life. It may worsen over the next few months. It is at its worst at around six months of age and then gradually improves. Natural stiffening of the airway will occur and most children will be symptom free by 24 months. For some children symptoms may persist for three to four years.

Laryngomalacia is usually diagnosed by clinical history and examination of the nose and airway by flexible laryngoscopy. Your child's doctor will visualize the airway using a tiny fiber-optic camera.

Symptoms:

  • Begins within the first few days of life or up to two months of age
  • Becomes louder on inspiration
  • Worse with crying, upper respiratory tract infections or when lying on back
  • May worsen over the first few months of life before improving
  • May lead to the development of gastric reflux due to the negative intra-thoracic pressure needed to overcome the airway obstruction

Managing Laryngomalacia

Your child's doctor will determine the severity of the condition and manage the symptoms accordingly.

Mild symptoms may be treated with an "acid blocker" or similar medication to prevent acid reflux from causing further swelling or damage to the airway. Weight and feeding will also be monitored.
Moderate symptoms may require additional monitoring and assessments.
Severe symptoms may require hospitalization and a surgical procedure to relieve the obstruction and correct the abnormality.

Notify your ENT physician or your primary care physician immediately if you notice:

  • Cyanosis or a blue color of the lips, face or body
  • Inward collapse of the chest (retractions), or other signs of difficulty breathing
  • Decreased ability to tolerate feedings; needing more rest periods while eating
  • Weight loss



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