LARYNGOSCOPE MERK RICHTER

LARYNGOSCOPE BAYI 3 DAUN 0.0001 MERK RICHTER
Treatment
Medical Care

In more than 99% of cases, the only treatment necessary for laryngomalacia is time. The lesion gradually improves, and noises disappear by age 2 years in virtually all infants. The noise steadily increases over the first 6 months, as inspiratory airflow increases with age. Following this increase, a plateau often occurs with a subsequent gradual disappearance of the noise. In some cases, the signs and symptoms dissipate, but the pathology may persist into childhood and adulthood. In those cases, symptoms or signs may recur with exercise or sometimes with viral infections.

If the baby has more noise and is uncomfortable when asleep, they may sleep prone, although one must then be careful to avoid soft bedding, pillows, and blankets. Initially, infants with laryngomalacia were exempt from the American Academy of Pediatrics' "Back to Sleep" campaign. More recently, the recommendations have been changed to indicate that these babies should sleep supine to reduce the likelihood of sudden infant death. Guidelines for preventive services for children and adults have been established.2

If the baby has clinically significant hypoxemia (defined as a resting oxygen saturation <90%), supplemental oxygen should be administered. Recent data suggest infants with laryngomalacia and hypoxemia may more readily develop pulmonary hypertension.3 Therefore, children with hypoxemia should periodically undergo evaluation for pulmonary hypertension.

If the baby has normal cry, normal weight gain, normal development, and purely inspiratory noise that developed within the first 2 months of life, then no further workup may be necessary. Parents may be told that laryngomalacia is the most likely diagnosis, and they can be assured of its natural history.

If the picture is not obvious or if the parents are not completely reassured, diagnostic procedures include fluoroscopy and flexible laryngoscopy or bronchoscopy. Flexible bronchoscopy with the child anesthetized is more specific and sensitive than flexible bronchoscopy in a child who is awake.
Surgical Care

In severe cases in which the laryngomalacia interferes with ventilation enough to impair normal eating, growth, and development, a surgical approach is possible.4

Operations include simple tracheotomy or laryngoplasty in which support structures are tightened and excess tissue on the epiglottis is removed. Laser epiglottopexy has been successful.5
Consultations

If the parents require another opinion or if the lesion is clinically severe, consultation with a pediatric pulmonologist or pediatric otorhinolaryngologist may help.
Diet

No diet restrictions are necessary.
Activity

No activity restrictions are necessary.
Medication

Drug therapy is not currently a component of the standard of care for laryngomalacia. In more than 99% of cases, the only treatment necessary is time.

The lesion gradually improves, and noises disappear by age 2 years in virtually all cases. See Treatment.
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