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Floppy larynx is a congenital condition where an infant's epiglottis and vocal folds are weak, tending to collapse and cause an abnormal cry and difficulty breathing. In many cases, as an infant matures, the condition resolves on its own, and the baby should not need any additional interventions. Infants who do not appear to improve can be offered surgical treatment to repair the structures in the throat and address the problem. People with muscular disorders can sometimes develop floppy larynx when they are older.
Known formally as laryngomalacia, this condition happens when the throat anatomy is weakened. When the baby cries or gets excited, the vocal folds can collapse, making the cry sound strange, and the baby may squeak or make other peculiar sounds. Stridor, a rattling, heavy sound while breathing, can also occur. If the infant appears to be in respiratory distress, a physician should be contacted immediately to provide emergency treatment.
Parents usually notice the symptoms and take their infants to a pediatrician for evaluation. Screening tests, including an endoscopy, where a camera is inserted into the throat to examine the larynx, are usually recommended. These tests are used to confirm a diagnosis of floppy larynx and rule out less benign causes of the symptoms. A wait and see approach will usually be advised to see if the condition resolves within the year, as the baby develops and the throat cartilage gets stronger.
When this condition persists, floppy larynx surgery can be performed. A neonatal surgeon or ear, nose, and throat physician can perform the surgery, repairing and reinforcing the throat so the baby can vocalize and breathe more comfortably. Risks of surgery include infection, damage to the throat, and permanent changes to the voice. Working with an established surgeon who has experience with these types of procedures can reduce risks significantly.
In adults, floppy larynx can happen as a result of progressive muscle weakness or connective tissue disorders. The condition onsets as the larynx deteriorates. Scoping of the throat can reveal the problem and surgery may be proposed as a treatment option to make the patient more comfortable. The underlying condition will continue to cause damage unless it can be treated, something that is not always possible. The risks of surgery are similar to those for infants and the surgery may be complicated if the patient has a chronic condition requiring special care with anesthesia or surgical procedures.
I worked at a nursing home for many years. One of our patients was an eighty-year-old man with a soothing voice. He often read to the others to put them at ease or help them get to sleep.
One night I noticed that his breathing seemed labored. He struggled a bit to inhale, and he emitted a rattling sound as he exhaled. The next day, he told me that he kept dreaming he was drowning.
He went to the doctor and got diagnosed with floppy larynx. They had to operate, and sadly, he lost his soothing voice. The change is permanent.
My friend’s baby had a floppy larynx. She seemed fine for the first two weeks, but in her third week of life, she started making a weird squeaking sound. She looked startled the first time she made that noise, and then she thought it was funny. She tried to laugh, but she started choking instead. My friend rushed her to the hospital, where she had emergency surgery. Today, she is fine.
My friend’s doctor told her some more about the condition. The doctor said that some babies are born with it and die within minutes of birth. Her baby was blessed to develop it a few weeks into life.
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