A child is brought with congenital stridor present since birth. The stridor is inspiratory, high-pitched, worse when supine, and the child feeds poorly but is growing along the 10th centile. Flexible nasopharyngoscopy shows an omega-shaped epiglottis with short aryepiglottic folds prolapsing over the glottis on inspiration. Which finding would indicate a need for surgical intervention (supraglottoplasty)?

• A Stridor persisting beyond 6 months of age
• B Stridor that worsens during upper respiratory tract infections
• C Failure to thrive (falling centiles), hypoxic episodes, recurrent aspiration, or cor pulmonale ✓
• D Parental anxiety about the noise affecting sleep quality

Explanation

Laryngomalacia resolves spontaneously in approximately 95% of cases by 18-24 months. Supraglottoplasty (laser or cold steel division of the aryepiglottic folds ± epiglottis trimming) is indicated only in severe cases with: failure to thrive (falling through weight centiles), significant recurrent hypoxia or oxygen desaturation on monitoring, recurrent aspiration pneumonia, feeding difficulties causing inadequate caloric intake, or cor pulmonale from chronic hypoxia. Stridor severity alone or parental concern without functional compromise is insufficient to justify surgery.

Reference: Dhingra Diseases of Ear, Nose and Throat, 7th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.