Congenital Laryngeal Stridor (Laryngomalacia)

Laryngeal stridor is a noisy or high-pitched sound that occurs with breathing. It’s caused by an abnormally formed voice box (larynx).

When this condition is present at birth, it’s called congenital laryngeal stridor (laryngomalacia), and it’s the most common cause of noisy breathing (stridor) in babies. During the baby’s development, the larynx may not fully develop. As a result, part of the larynx is weak, causing the soft tissues of the larynx to fall over the airway opening and partially block it during breathing.

While in most cases congenital laryngeal stridor is a harmless condition that goes away on its own by the time a child is 20 months old. Some babies, however, develop severe breathing problems that need treatment. That’s why, if your baby shows signs of stridor, it’s important to have him or her evaluated by your pediatrician, who may refer you to an otolaryngologist (ear, nose, and throat specialist).

Importantly, should your baby have trouble breathing, call 9-1-1 or your local emergency number immediately.

Why Choose Cooper to Treat Congenital Laryngeal Stridor

With their advanced training and experience, Cooper’s team of otolaryngologists—ear, nose, and throat specialists—are uniquely qualified to treat children with this condition, and they have a proven track record of successful outcomes.

In addition, our ENT specialists are proficient in today’s most advanced minimally invasive surgical techniques, including transoral robotic surgery (TORS) and transoral laser microsurgery (TOLM).

Symptoms of Congenital Laryngeal Stridor

The main symptom of congenital laryngeal stridor is the high-pitched sound you hear when your baby breathes. It is best heard when your baby breathes in (inhales), but can also be heard when your baby breaths out (exhales).

In addition, stridor can:

  • Change with activity
  • Be present during eating, sleeping, or excitement
  • Become less noisy when the baby is lying on his or her belly
  • Get worse if your baby has an upper respiratory infection, like a cough or cold

Other symptoms of more severe congenital laryngeal stridor can include:

  • Difficulty feeding
  • Poor weight gain
  • Choking while feeding
  • Apnea (pauses in breathing)
  • Pulling in neck and chest with each breath
  • Cyanosis (a bluish cast to the skin, usually caused by low oxygen levels)
  • Gastroesophageal reflux (spitting, vomiting, and regurgitation)
  • Inhalation of food into the lungs (aspiration)

How Congenital Laryngeal Stridor Is Diagnosed

Your pediatrician will ask about your baby’s symptoms and health history, and give your baby a physical exam. You may then be referred to an ear, nose, and throat (ENT) specialist (otolaryngologist) for further diagnostic testing. This may include:

  • Nasopharyngolaryngoscopy (NPL), an office-based test in which a tiny camera that resembles a strand of spaghetti with a light on the end is inserted through your baby’s nostril into the lower part of the throat where the larynx is, enabling your doctor to see the voice box
  • X-ray of the neck
  • Airway fluoroscopy (moving picture x-rays)
  • Laryngoscopy, examination of the larynx while your baby is anesthetized in the operating room
  • Bronchoscopy, an exam of the inside of the trachea and bronchi (the air passages into the lungs), below the larynx; this exam is done through the mouth with a small camera.

How Congenital Laryngeal Stridor Is Treated

Treatment will depend on your baby’s symptoms, age, general health, and how severe the condition is. Treatment may include: 

  • Observation: Indicated for patients with minor obstruction and no breathing problems
  • Medications: Reflux medication and/or steroids to reduce airway swelling
  • Surgery: A procedure called supraglottoplasty is recommended when the condition is severe. This surgery is done through the mouth (transoral) and a laser or surgical instruments may be used to remove tissue in the upper larynx that is obstructing the airway. This procedure takes about an hour.

Contact Us

To learn more about the services available in the Division of Otolaryngology—Head and Neck Surgery or to schedule an appointment, please call 856.342.3113.