A 6-month-old infant presents with intermittent inspiratory stridor since birth, exacerbated by crying and feeding, with no cyanosis. The cry is normal. Laryngoscopy in the awake state shows an omega-shaped epiglottis and prolapse of the aryepiglottic folds on inspiration. The diagnosis and initial treatment are:
- A Laryngomalacia; conservative management with reassurance in mild cases; supraglottoplasty for severe cases ✓
- B Tracheomalacia; prone positioning and CPAP
- C Subglottic hemangioma; propranolol therapy
- D Bilateral vocal cord palsy; tracheostomy
Explanation
Laryngomalacia is the most common cause of congenital stridor in infants, presenting with inspiratory stridor from birth that worsens with crying and feeding due to collapse of supraglottic structures. The classic findings are an omega-shaped or tubular epiglottis, short aryepiglottic folds, and redundant arytenoid mucosa prolapsing into the airway on inspiration. Most cases (90%) resolve spontaneously by 12–18 months and require only reassurance. Severe cases with feeding difficulties, failure to thrive, or hypoxia are treated with supraglottoplasty (endoscopic division of short aryepiglottic folds and redundant mucosa removal).
Reference: Dhingra Diseases of Ear, Nose and Throat, 7th ed.
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Written and medically reviewed by the StethoPrep medical team.