A 6-week-old boy has had noisy breathing for 3 weeks, worse when he lies supine or cries, and quieter when he is prone. Feeding is slow but he gains weight, and his cry is normal. Flexible laryngoscopy shows inward collapse of the supraglottic structures during inspiration with an omega-shaped epiglottis. What is the most likely diagnosis?

• A Laryngeal web
• B Congenital vocal cord paralysis
• C Subglottic stenosis
• D Laryngomalacia ✓

Explanation

Laryngomalacia is the commonest congenital laryngeal anomaly and the commonest cause of stridor in neonates. Immature supraglottic cartilage collapses on inspiration; stridor is positional, worse supine and improved prone, with a normal cry and thriving infant. Omega-shaped epiglottis is typical. Vocal cord paralysis gives biphasic stridor with weak cry, while subglottic stenosis and laryngeal web produce stridor unrelated to posture.

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

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Written and medically reviewed by the StethoPrep medical team.