A 6-week-old infant presents with inspiratory stridor that worsens when supine and improves when prone. The stridor is present since birth and has not worsened. The child feeds well and has normal weight gain. Flexible laryngoscopy reveals omega-shaped epiglottis and redundant arytenoid mucosa with inward collapse on inspiration. What is the recommended management?
- A Observation and reassurance, as most cases resolve spontaneously ✓
- B Rigid bronchoscopy under general anesthesia
- C Immediate supraglottoplasty
- D Systemic corticosteroids for 2 weeks
Correct answer: A. Observation and reassurance, as most cases resolve spontaneously
Explanation
Laryngomalacia is the most common cause of infantile stridor. Typical findings include inspiratory stridor worsening supine, omega-shaped epiglottis, and arytenoid prolapse. In the absence of failure to thrive, apnea, or cor pulmonale, management is observation. Over 90% of cases resolve spontaneously by 12 to 18 months. Supraglottoplasty is reserved for severe cases with feeding difficulties or respiratory compromise.
Reference: Cummings Otolaryngology: Head and Neck Surgery, 7th ed.
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Written and medically reviewed by the StethoPrep medical team.