Laryngomalacia is a condition where a baby is born with soft or floppy tissue around their voice box. This can cause noisy breathing or difficulty feeding.
Tracheomalacia is a similar condition, except the soft tissue is in the windpipe. Normally, the windpipe is rigid so that it is always open. This allows for easy airflow and easy breathing. Infants with tracheomalacia have a soft or floppy windpipe that causes difficult or noisy breathing.
In babies with laryngomalacia, symptoms may be present at birth or in the first months of life. The most common symptom is noisy, high-pitched breathing, particularly while breathing in. Other symptoms include:
In babies with tracheomalacia, the most common symptoms are similar to those of laryngomalacia. In mild cases, the child may have no symptoms at all. Some other symptoms include:
In newborns, both laryngomalacia and tracheomalacia are congenital. This means the child was born with it.
There is an association with reflux symptoms in both conditions. Researchers are not sure whether reflux causes the problem, makes the problem worse, or whether the laryngomalacia/tracheomalacia causes the reflux. There is also an association with other birth defects such as heart defects.
The diagnosis of both laryngomalacia and tracheomalacia begins with a paediatrician (doctor who treats children) who will perform a complete history and physical examination. They will then refer the child to a consultant paediatric otolaryngologist. This is a doctor who specialises in diagnosing and treating disorders of the ears, nose, and throat in children.
The paediatric otolaryngologist will perform a test called a flexible laryngoscopy. During the test, the doctor inserts a camera attached to a small wire down the child’s windpipe to the voice box. This allows the doctor to see the floppy tissue while the child breathes and make the diagnosis.
In severe cases, the doctor may perform a similar test in the operating room with the child asleep. This allows for surgical correction if needed. If there is concern for further airway disease, the doctor may also request a camera investigation of the airways of the lungs, called a bronchoscopy.
The doctor may also request other tests, such as:
Complications of both laryngomalacia and tracheomalacia may include:
For mild or moderate laryngomalacia, the doctor will often recommend watching the child’s symptoms. The doctor will prescribe medications to help with reflux symptoms. They may recommend feeding the infant while sitting upright. Many children will outgrow laryngomalacia by the age of 12 to 24 months. For severe laryngomalacia, surgery may be required.
For mild or moderate tracheomalacia, the doctor will also often recommend watching the symptoms. For these infants, medical treatment of reflux symptoms is important. The doctor may also prescribe inhaled medications. If the child develops a chest infection, the healthcare team will watch them closely while treating with antibiotics. Most of these children will also outgrow the disease. For severe tracheomalacia, surgery or a stent to keep the airway open may be required.