Overview

• Condition affecting infants → the supraglottic larynx (part of larynx above vocal cords) is structured in a way that it causes partial airway obstruction [CONGENITAL ABNORMALITY OF THE LARYNX CAUSING PARTIAL AIRWAY OBSTRUCTION].
  • Aryepiglottic folds are shortened, pulling on the epiglottis and changing it to a ‘omega’ shape.

Making Diagnosis

Clinical Features

• Peak incidence at 6 months.

• Inspiratory Stridor → harsh whistling sound when breathing in.

  • Intermittent. Worse when feeding, upset, lying on back or during URTIs.

  <aside> 💡 Commonest cause of noisy breathing (stridor) in infants. [Other Causes = croup, acute epiglottitis, inhaled foreign body]. Suspect in otherwise well infant with noisy breathing.

  </aside>

• If Severe → failure to thrive + respiratory distress.

Investigations

Management Plan

• Mild Disease ⇒
  • Observation + Reassurance (as no respiratory distress or failure to thrive).
  • Feed infants upright.
  • GORD Therapy → thickened feeds (1st line), omeprazole (2nd line), nissen fundoplication (3rd line).
• Moderate Disease ⇒
  • Observation (patient may have increased work of breathing and weight loss).
  • GORD Therapy.
  • Surgical Therapy → endoscopic supraglottoplasty or tracheostomy.
  • May need BiPAP.
• Severe Disease ⇒
  • Surgical Therapy (Endoscopic Supraglottoplasty) + BiPAP + GORD Therapy.

Complications →

Prognosis → usually self-resolves before 2 years of age.