Laryngomalacia or floppy larynx

What does a normal airway look like?

A normal airway has plenty of space and is wide open to let air pass through.

What is a floppy larynx?

The aryepiglotic folds fall inwards resulting in noisy breathing (stridor), difficulty feeding and sometimes increased effort in breathing.

If babies with this problem manage to feed well and gain weight then no operation is necessary as it usually goes away without any treatment by the age of 18 months.

What happens if my baby has a suspected floppy larynx?

The Ear, Nose and Throat (ENT) consultant will examine your baby. They may decide to continue to observe them.

Alternatively they may do a flexible laryngoscopy where a small camera is passed into your baby’s nose allowing the larynx to be examined. It is painless, although your baby will cry, which helps to make the diagnosis. It takes minutes and your baby usually settles straight away afterwards. Although this procedure may confirm the consultant’s diagnosis your baby may still need to go to theatre to have the floppy larynx treated.

The consultant may decide to prescribe some anti-reflux medication like Gaviscon, omeprazole, domperidone or cimetidine. This helps because quite often babies who have a floppy larynx also suffer from a red, sore airway which is caused by acid going back up into their throat from their stomach (similar to indigestion).

They may also decide to take them to theatre to enable them to make a more accurate assessment of your baby’s airway.

How is a floppy larynx treated?

If your ENT consultant finds that your baby does have this condition, then as part of your baby’s operation, they will divide the aryepiglottic folds and remove any extra tissue at the same time.

Due to your baby’s age the anaesthetist may want them to be cared for on the High Dependency Unit (HDU) following the operation. This is just a precaution.

Your baby’s breathing may become quieter straight away, although sometimes the breathing becomes louder for a little while. This is cause by swelling inside the airway following the operation.

Your baby would be closely monitored, at least overnight and sometimes longer. If they did struggle again with their breathing straight after the operation, then medication can be given to help with this.

Your baby may find it uncomfortable to feed due to having a sore throat, for which the nurses may give them pain relief medication.

Once your baby is feeding well and you and the ENT team are happy with your baby’s progress they will be able to go home.

Will my baby need to see the ENT consultant again?

Your baby will be given an outpatient appointment to see their ENT consultant usually 6 to 8 weeks after the operation.

What should I do if I am worried about my baby after they have been discharged home?

If your baby’s noisy breathing returns, your baby stops feeding or begins to struggle with their breathing you can contact the hospital at any time.