A 6-week-old infant has had inspiratory stridor since two weeks of age. The stridor worsens when the baby lies supine and during crying, improves in the prone position, and there is no feeding difficulty or cyanosis. Flexible endoscopy would show inward collapse of the supraglottic structures on inspiration. What is the most likely diagnosis and its usual course?

• A Laryngeal web, requiring surgical division in all cases
• B Vocal cord paralysis, requiring tracheostomy in most cases
• C Subglottic hemangioma, enlarging until 12 months then involuting
• D Laryngomalacia, resolving spontaneously by 12 to 18 months ✓

Explanation

Laryngomalacia is the most common congenital laryngeal anomaly and the most common cause of stridor in neonates. Immature supraglottic tissue collapses inward during inspiration, producing stridor that characteristically worsens supine and on agitation and improves prone. About 90 percent resolve spontaneously by 12 to 18 months. Supraglottoplasty is reserved for severe cases with feeding failure, failure to thrive, or hypoxic spells.

Reference: Dhingra's Diseases of Ear, Nose and Throat, 8th ed.

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Written and medically reviewed by the StethoPrep medical team.