Laryngomalacia: causes, symptoms, diagnosis, treatment

Laryngomalacia is a defect in the development of the larynx, during which the prolapse of the tissue of the vestibule occurs in its lumen during inspiration, due to their abnormal compliance or due to neuromuscular laryngeal insufficiency.

[1], [2], [3], [4], [5], [6], [7], [8], [9]

What causes laryngomalacia?

Two causes of laryngomalation are considered: genetically conditioned laryngomalacia and acquired. The first reason, according to McCusick's assumption, is due to the autosomal dominant nature of inheritance, the second is the effect of adverse effects on the fetus in the prenatal period, various neuro-myogenic dysfunctions of the stomach and esophagus (gastroesophageal reflux), etc. As A.Yu. Petrunichev notes ( 2004), a number of authors consider laryngomalacia in adults as a result of an increase in the flow of air passing through the larynx in athletes during extreme physical exertion or as a result of an infringement of the inn The maintenance of the corresponding muscular apparatus of the larynx.

Symptoms of laryngomalacia

The most frequent symptoms of laryngomalacia are the inspiratory stridor and all the spasms associated with it. Of the other symptoms of this disease, shortness of breath is noted, especially with physical exertion, child's hypodynamia, developmental lag, choking, sleep apnea, complications of the lungs and heart, and even sudden infant death syndrome. Often laryngomalacia is combined with a laryngeal congenital stridor.

Usually, in connection with the age-related development of the larynx, as a result of which its cartilaginous skeleton becomes denser, the muscular, ligamentous and fibrous apparatus of the larynx is strengthened, signs of laryngomalacia disappear to the 2-3th year of the child's life. Promote this early diagnosis and the conduct of appropriate treatment and rehabilitation activities. However, in their absence, restoration of laryngeal structures can be delayed for quite a long time. In this case, the physical development of the child lags behind, frequent catarrhal diseases, which intensify the symptoms of laryngomalacia, disturbances in the function of external respiration, and other anomalies associated with this condition, which results in a "narrowing" of the person's normal way of life and acquires not only medical, but also social significance.

According to the works of EA Tsvetkov and A.Yu. Petrunichev, the clinical and pathogenetic characteristics of laryngomalacia can be determined by the following postulates:

1. signs of laryngomalacia are not only known laryngeal symptoms, but also gastroesophageal reflux and funnel-like deformity of the child's thorax;
2. macrostructural laryngeal anomalies in laryngomalacia can persist in older children, and even in adults, causing a negative impact on the functions of the larynx and the body as a whole;
3. in the development of some cases of laryngomalacia, a certain role is played by dysplastic processes in connective tissue;
4. At least 25% of cases of laryngomalacia are represented by family forms, which indicates the hereditary nature of this disease.

Thanks to the research of A. Yu. Petrunichev conducted under the guidance of E. A. Tsvetkov, we have the opportunity to present some unique data obtained by these authors concerning the dynamics of the morphofunctional compensation of laryngomalacia. All patients were divided into 5 groups.

• The first group: an increase in the vertical size of the wedge-shaped cartilage, combined with the thinning of scapular-folded folds.
• The second group: cherpalodnagortannye folds are thinned in the upper parts and attached high to the epiglottis. In the same group, the variant is noted, in which the scapular folds are also thinned and have the appearance of cup-shaped "sails", which are drawn in the middle to the side walls of the pharynx (2).
• The third group: the epiglottis is folded and pulled backward with short, cherpal-nodular folds.
• The fourth group: the form of an epiglottis is usual, but during phonation, it freely leans forward, lying on the root of the tongue. Its stem plays a significant role in the lumen of the larynx, and cherpalodnagortannye folds spread along its lateral surfaces.
• Fifth group: excess tissues of the posterior sections of the anterior larynx.

Diagnosis of laryngomalacia

Diagnosis of larynomalacia involves a systematic approach to this problem, developed by A.Yu. Petrunichev (2004). The method proposed by the author is of universal significance, since it can be used to diagnose not only laryngomalacia, but also other malformations of the larynx. This method includes:

1. the recording of complaints, the collection of data on anamnesis of the disease and the life of the child, most often obtained from the parents of the child; when collecting an anamnesis, the fact of a possible inheritance of the disease is also taken into account;
2. carrying out endofibrolaringoscopy of the child through the nose;
3. radiography of the neck (larynx) in the lateral projection;
4. conducting direct support laryngoscopy under anesthesia (under special indications);
5. conducting a general physical examination of the child;
6. the collection of an anamnesis of life and, if necessary, a physical examination of the parents and other immediate relatives of the child for the establishment of the fact of the inheritance of the disease.

The formulation of the diagnosis of laryngomalation A.Yu. Petrunichev suggests conducting in accordance with the classification of criteria developed by him (2004):

1. in form - light and severe degree of laryngomalacia;
2. for the clinical period (stage) - compensation, subcompensation and decompensation;
3. on the clinical course - typical and atypical (severe, asymptomatic, prolonged).

[10], [11], [12], [13], [14], [15]

Laringomalacia treatment

Laringomalacia treatment is basically the same as in congenital stridor. With pronounced anatomical changes that significantly impair the respiratory and voice-forming function of the larynx, the corresponding surgical intervention aimed at strengthening the walls of the vestibule of the larynx is shown.

What is the prognosis of laryngomalacia?

Laryngomalacia has a favorable prognosis, however, in severe forms, especially with prolonged forms, it can be questionable regarding both severe respiratory complications and a full-fledged voice function.