Laryngomalacia: Definition, Causes, Symptoms, Diagnosis and Treatment

The larynx structures, including the epiglottis, are made of cartilage.

The arytenoids are the ball joints in which the vocal cords rotate.

Aryepiglottic folds are the tissue that connects the epiglottis to the arytenoids and can be short, pulling the epiglottis, and arytenoids close together.

Laryngomalacia is a condition that results from a congenital disability in the larynx.

The larynx’s soft tissues fall over the airway opening and partially block it. This can cause stridor (a high-pitched sound heard when inhaled).

Laryngomalacia is sometimes called congenital laryngeal stridor and is the most common cause of noisy breathing in babies.


Stridor is a high-pitched, screeching noise that can be heard when the airways are narrowing at the level of the larynx or trachea. It is like water flowing through a river.


When the river is wide, the water is relatively calm and quiet. When the river narrows, the water becomes more turbulent, resulting in rapids, which are much louder; stridor is the sound of turbulent airflow.

Causes of laryngomalacia

The exact cause of laryngomalacia is not known. Lack of good muscle tone in the upper airway can contribute to the condition. The underlying cause of laryngomalacia is currently unknown.

Although the condition was initially thought to be caused by abnormalities in the cartilage or the general structure of the larynx, more recent studies, suggest that this is not the case.

Researchers believe that an underlying neurological cause is likely responsible for the condition.

Disease GERD has also been studied as a possible contributing factor. Laryngomalacia can be inherited on certain occasions. Only a few cases of laryngomalacia occur in more than one family member.

Laryngomalacia is also associated with several syndromes. In cases where these specific syndromes are inherited, there may be a predisposition to be born with laryngomalacia.

Syndromes that have been associated with laryngomalacia include diastrophic dysplasia, universal congenital alopecia, XY gonadal dysgenesis, Costello syndrome, DiGeorge syndrome, and acrocallosal syndrome.

The pattern of inheritance depends on the specific syndrome present.


Symptoms of laryngomalacia can begin at birth or shortly after that.

The baby will make a soft, high-pitched sound when he inhales. This is known as inspiratory stridor. The noise may get louder when your baby is feeding, lying, or crying.

You may also notice that the baby’s breast appears to be suckling in the area between the clavicle (suprasternal retractions) or between the lower ribs (substernal retractions).

It is often worse when your baby is on his back because flexible tissues can fall into the airway and open more quickly in this position.

Other symptoms can include:

  • Difficulty feeding.
  • Little weight gain
  • Choking while feeding.
  • Apnea (pause in breathing).
  • Cyanosis .
  • Gastroesophageal reflux (spitting up, vomiting, and regurgitating).
  • Inhalation of food into the lungs (aspiration).

Diagnosis of laryngomalacia

When a diagnosis of laryngomalacia is suspected based on the presence of characteristic signs and symptoms, additional tests may be ordered to confirm the diagnosis, assess the severity of the condition, and rule out other disorders associated with similar features.

These tests can include:

  1. Flexible fiberoptic laryngoscopy (Naso laryngoscopy).
  2. Airway fluoroscopy.
  3. Direct laryngoscopy.
  4. Bronchoscopy.


Some babies with laryngomalacia have such difficulty breathing and feeding that they cannot gain weight properly.

Other babies have so many obstructions in their airways that they cannot get enough oxygen and turn blue. In these cases, surgery must be performed.

The otolaryngologist will closely observe the larynx and trachea during laryngoscopy and bronchoscopy, looking for any other structural airway abnormalities contributing to the problems.

The most widely used procedure is supraglottoplasty. There are many ways to perform this procedure: scissors, laser, microdebrider, etc.

It usually consists of dividing the aryepiglottic folds to allow the epiglottis and arytenoids to separate and reduce the tissue of the arytenoids.

Manipulating the tissues of the larynx can cause swelling, which may temporarily worsen breathing before it improves.

Many babies with laryngomalacia can eat and grow normally, and the condition will usually resolve without surgery by 20 months.