The Cribsiders S7 Ep149: Squeaks, Squawks, and Stridor: Approach to Laryngomalacia
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Aug 13, 2025 In this engaging conversation, Dr. Eileen Rayner, a pediatric otolaryngologist at Duke and leader of their Pediatric ENT Program, shares her expertise on laryngomalacia. She explains how to recognize its signs and the importance of scoping in diagnosis. The discussion highlights effective management strategies, including when surgical intervention may be necessary. Listeners will appreciate her insights on balancing a medical career with personal life and the critical techniques for assessing respiratory sounds in infants.
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When And How To Scope
- Diagnose supraglottic laryngomalacia with awake flexible nasopharyngoscopy watching inspiratory collapse.
- Do not attempt transglottic flexible scopes in awake infants; use anesthesia for deeper evaluation.
Anatomic Types Don't Dictate Treatment
- Laryngomalacia patterns fall into three anatomic types: floppy arytenoids, short aryepiglottic folds, or omega/floppy epiglottis.
- Treatment decisions hinge more on symptom severity than the specific anatomic subtype.
When To Refer To ENT
- Refer to ENT when infants show failure to thrive, apneas, persistent retractions, or parental concern without improvement.
- Arrange closer follow-up (monthly to six-weekly) while monitoring growth and breathing.