Laryngomalacia in Infants: What the Research Tells Us
Laryngomalacia is the most prevelant cause of stridor for infants, impacting up to 75% of all infants with congenital stridor (Klinginsmith et al., 2024; Landry & Thompson, 2012). Although multiple causeal therories have been proposed, the etiology of laryngomalacia is immature cartilages of the infant larynx resulting in collapse upon inspiration resulting in stridor, with neurologic dysfunction one of the leading theories suggestive of alterted laryngeal tone due to abnormal integration of the laryngeal nerves (Thompson, 2007).
Disease presentation, progression and outcomes vary, however,early diagnosis is important due to the potential impact of laryngomalacia on growth and development (Klinginsmith et al., 2024; Landry & Thompson, 2012). Flexible laryngoscopy is the primary diagnostic evaluation tool allowing for visualization of the upper aerodigestive tract.
Current literature demonstrates a coexistence between acid reflux and laryngomalacia but evidence for a causal association remains limited (Hartl & Chadha, 2012). Symptoms of laryngomalacia may include stridor and noisy breathing. Management of laryngomalacia is dependent upon disease presentation. Interventions may include positional feeding, thickened liquids, and acid suppression intervention (Thorne & Garetz, 2015).
For the majority of infants, symptoms resolve by the age of 12 to 18 months without the need for surgical intervention (Klinginsmith et al., 2024). Those with stridor who do not have significant feeding-related symptoms are often managed without intervention, while those with stridor and feeding-related issues may benefit from acid suppression intervention, and those who have additional symptoms such as failure to thrive, aspiration, and issues secondary to airway obstruction may require surgical intervention (Landry & Thompson, 2012). Although acid suppression has been recommended for those with laryngomalacia, studies indicate that it may not provide any additional benefit compared to feeding modifications and may not reduce the frequency of supraglottoplasty and related hospital admissions (Duncan et al., 2022)
In summary: For most infants with laryngomalacia who have mild-to-moderate symptoms, no surgery is required. Those who have reflux and/or laryngopharyngeal reflux may benefit from acid suppresion intervention and/or feeding modifications. Supraglottoplasty may be beneficial for those with severe enough disesae, with research demonstrating positive outcomes for those with minimal comorbidities (Landry & Thompson, 2012; Johnston, 2025).
Interested in learning more? Check out the references cited in this post.
