How to Diagnose Laryngomalacia

Laryngomalacia means "soft larynx" and occurs when the cartilage in the upper larynx collapses while inhaling. It is seen primarily in patients with weak throat muscles and is extremely common in infants. A clinician normally uses the term "laryngomalacia" only when this condition is severe enough to interfere with normal development.

Instructions

• 1

  Gather the patient's history, particularly with regard to breathing noises. Laryngomalacia typically begins to cause inspiratory noises within the first 2 months of life. This noise may be a high pitched crow and is usually louder when the patient is in a supine position.

• 2

  Conduct a general physical. Most cases of laryngomalacia are otherwise asymptomatic, although the respiration rate may be slightly increased. A noise that persists during exhalation or an abnormal cry should indicate some other problem.

• 3

  Perform imaging studies. A lateral view of the airway with a fluoroscope should allow a pediatric radiologist to observe the cartilage collapsing during inspiration. Confirm a diagnosis of laryngomalacia with a laryngoscopy and bronchoscopy. A bronchoscopy under anesthesia is more sensitive and should be performed by a pediatric pulmonologist or otorhinolaryngologist.

• 4

  Visualize the airway directly. The epiglottis should be omega-shaped and prolapse during inspiration. The arytenoid cartilages may be enlarged and prolapse as well.

• 5

  Classify the laryngomalacia. Type I is an inward collapse of the aryepiglottic folds; Type II is a tubular epiglottis that curls on itself; Type III is an anterior and medial collapse of the cuneiform and corniculate cartilages; Type IV is a posterior displacement of the epiglottis during inspiration; and Type V laryngomalacia is characterized by short aryepiglottic folds.