Laryngomalacia in Infants

Laryngomalacia is common and treatable, MUSC Health pediatric otolaryngologist says.

When an infant’s breathing is unusually noisy, the most common cause is laryngomalacia, a congenital condition caused by a softening of tissue above the vocal cords in the voice box.
“Babies with laryngomalacia usually have stridor, a high-pitched, squeaky noise due to excess tissue above the vocal cords that creates a blockage in the airway as the baby inhales,” says Phayvanh Pecha M.D., professor of pediatric otolaryngology and a head and neck surgeon at MUSC Health. 

Here, Dr. Pecha defines laryngomalacia and explains its symptoms and how it's diagnosed and treated. 

What are the symptoms of laryngomalacia? 

Laryngomalacia is extremely common in infants and can be present at birth or become noticeable in the first month of life. Breathing usually gets louder with crying, feeding, or lying down. 

Although the cause of laryngomalacia is not known, a lack of sensation and muscle tone are factors, Dr. Pecha says. Gastroesophageal reflux can also make laryngomalacia symptoms worse. 

“The noisy breathing can get louder between four and eight months,” she says. “The good news is that most babies outgrow the condition between 18 and 20 months.” 

In severe cases, however, infants can inhale food or fluid into the airway.

“What is important is not so much the noisy breathing, but symptoms such as difficulty swallowing, poor weight gain, working hard to breathe, or blue spells,” Dr. Pecha says.

She and her team have adopted a holistic approach to determine if a baby has other contributing problems.

Diagnosing laryngomalacia

To diagnose the condition, she inserts a laryngoscope, a narrow tube equipped with a camera, through the nasal passages to examine the voice box. Breathing and swallowing go hand in hand for babies, so speech-language pathologists can perform a swallow study to assess a baby’s swallow coordination and any signs of aspiration, or fluid going into the baby’s airway.

“Most kids who have laryngomalacia are otherwise healthy, but if it’s severe enough, we typically know sooner rather than later if an intervention is needed. Babies who are doing well in the first few months, gaining weight, have no blue spells or chest or neck retractions, probably do not need surgery to treat the laryngomalacia,” Dr. Pecha says. 

Treatment for laryngomalacia

Treatment varies. Some babies don’t require any treatment. For mild cases, anti-reflux medications to help with spitting up are prescribed. Surgery may be necessary for severe cases. The procedure, a supraglottoplasty, involves removing the extra tissue above the vocal cords to reduce airway blockage. It is done under general anesthesia.

All children are followed closely for at least a year regardless of their symptoms. “We need to follow them closely during their first year of life to make sure they are growing and progressing well,” Dr. Pecha says. 

“When it comes to treatment, we rely on shared decision-making with the parents and often use a multidisciplinary approach involving other specialists to determine if their expertise is needed to help ensure a good outcome.”

For new parents who are uncertain if their newborn has a breathing or swallowing problem, Dr. Pecha urges them to schedule an evaluation. 

“Parents are the first to notice if something isn’t quite right. Whenever parents feel something is wrong, whether it’s hearing, breathing, or swallowing issues, they should bring them in for an evaluation to ensure a diagnosis and treatment if needed. We treat a wide spectrum of conditions, from hearing, breathing, and swallowing conditions to cleft lip and palate concerns.”

Dr. Pecha sees patients at the MUSC Children’s Health R. Keith Summey Medical Pavilion in North Charleston. To schedule an appointment, call 843-876-0444.