PEDIATRIC EXERCISE-INDUCED LARYNGOMALACIA

Laryngomalacia is a well-recognized cause of airway obstruction and in spiratory strider in infants. As children grow and become more active, laryngomalacia may manifest in different, unexpected ways. Otherwise healthy athletes may generate enough inspiratory force to draw the ary epiglottic folds into the endolarynx, causing a subtotal glottic obstr uction. This problem may be overlooked or attributed to asthma, lack o f fitness, or functional abnormalities. The purpose of this report is to review the prevalence, diagnosis, and treatment of exercise-induced laryngomalacia (EIL) in children and young adults. To study the incid ence and diagnosis of this disorder, we examined 10 healthy volunteers . Fiberoptic laryngoscopy was used to videotape each subject's larynx during active exercise on a stationary bicycle. All volunteers demonst rated altered laryngeal dynamics with exercise, and 1 of the 10 volunt eers developed laryngomalacia. Anatomically, it appears that the aryep iglottic fold serves as the critical point of obstruction. When sympto matic, laryngomalacia may be treated with supraglottoplasty. We have h ad experience with 2 EIL patients in the last 12 months who have under gone carbon dioxide laser microlaryngoscopy with supraglottoplasty. Bo th patients benefited significantly from surgery. We conclude that EIL is underdiagnosed but responds well to treatment.