Laryngomalacia, tracheomalacia and vocal-cord dysfunction

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Target exams

Red flags

• Apnoea, cyanosis or a 'dying spell' in an infant with stridor signalling severe laryngomalacia
• Faltering growth or feeding failure in a child with dynamic airway collapse
• Stridor present from birth or in the first hours of life, which points away from simple laryngomalacia to a fixed lesion
• Biphasic stridor, a weak or abnormal cry, or stridor that fails to improve, suggesting a second airway lesion
• A barking, seal-like cough with wheeze that does not respond to bronchodilators, suggesting tracheomalacia rather than asthma
• Sudden exertional inspiratory stridor with throat tightness in an adolescent labelled as refractory asthma
• An acute cyanotic collapse (reflex apnoea) during a feed or a viral illness in a child with tracheomalacia

Life stages

Care settings

Clinical exam formats

Board mappings

• Recognises laryngomalacia as the commonest cause of infant stridor and describes its natural history
• Localises a noisy airway by the phase of the respiratory cycle
• Identifies the red flags that separate benign from severe dynamic airway collapse
• Justifies awake flexible laryngoscopy versus dynamic bronchoscopy in the noisy-airway work-up
• Differentiates tracheomalacia from asthma and explains the salbutamol trap
• Plans surgical escalation to supraglottoplasty or airway surgery for severe disease
• Assessment of the infant with stridor and feeding difficulty
• Recognition of severe laryngomalacia needing intervention
• The child with a barking cough and wheeze unresponsive to bronchodilator
• Bedside assessment of the stridulous infant and the exercising adolescent
• Communicating the benign natural history of laryngomalacia to anxious parents
• Counselling a teenager and family on vocal-cord dysfunction and breathing retraining
• Level 1: Recognises stridor and the red flags for urgent airway referral
• Level 2: Diagnosis and initial management of laryngomalacia and tracheomalacia
• Level 3: Coordinates airway surgery, ventilatory support and multidisciplinary care
• Causes of stridor by age and the localising value of respiratory phase
• Pathophysiology of dynamic airway collapse and vocal-cord dysfunction
• Indications for supraglottoplasty, aortopexy and speech therapy
• History and examination of the infant with noisy breathing
• Structured assessment of the adolescent with exertional breathlessness
• Communication of a benign diagnosis and its safety-net
• Diagnosis of laryngomalacia and the natural history of resolution
• Distinguishing tracheomalacia and vocal-cord dysfunction from asthma
• Recognition of severe airway collapse requiring intervention
• Evaluation of stridor and dynamic airway obstruction in children
• Risk-stratified management from reassurance to airway surgery
• Recognition and initial stabilisation of the acute airway collapse
• Assessment of the Canadian child with congenital stridor
• Management pathways for severe laryngomalacia and tracheomalacia
• Multidisciplinary care of vocal-cord dysfunction and EILO in adolescents