Laryngomalacia is a malformation of the top of the voice box at birth, which causes floppiness of the upper airway above the vocal cords. It is the most common cause of noisy breathing in infants. Children and infants who have laryngomalacia have noisy breathing (stridor) from birth, when they inhale. This noisy breathing can worsen with activity, agitation, sleep or feeding and is usually noted with the first few days to weeks of life. Laryngomalacia can be associated with acid reflux, which can worsen the child’s symptoms. Most cases are managed conservatively with close follow up in clinic and with stomach acid suppression medications. In these cases, symptoms resolve by 18-24 months of life.
In some cases, severe breathing symptoms cause poor feeding and poor weight gain, and a brief surgical procedure called a supraglottoplasty is performed, generally improving symptoms. A supraglottoplasty involves trimming some of the excess tissue above the vocal cords, creating more space for air to go through.