1. Alyssa Brzenski MD ENT PATHOLOGY

2. Case A 34 week old premature baby boy was born vaginally to a young mother with chorioamnioitis. At birth the baby was tachypneic and required intubation. Blood cultures were performed and came back positive, so the NICU started the baby on IV Penicillin and Gentamycin for 14 days. He was given surfactant x 3 doses and remained intubated for 7 days. Upon finishing his antibiotic regime, he was allowed to go home with his mother. 2 - 3 weeks later, the mother appears at the pediatricians office with the baby and complains that “the baby turns blue, he’s noisy when he breathes and she has difficulty feeding him.”

3. “Noisy Breathing” Definition

4. Differential Diagnosis

5. Evaluation of Stridor

6. Laryngomalacia- The Facts Most common laryngeal anomaly and cause of stridor (54-75%) DEFINITION: “Flaccid laryngeal tissue and inward curling of supraglottic structures during inspiration. There is a fluttering inspiratory stridor that worsens with agitation, crying, feeding or supine.” Begins in 1 st weeks of life and peaks at 6-8 months

7. Normal Pediatric Anatomy

8. Laryngomalacia

9. Treatment

13. Supraglottoplasty

14. Before and After

15. CO2 vs YAG Laser TypeAdvantageDisadvantageOther CO2 LaserPrecise; Decreased Post-op Edema Takes longer for bigger areas Invisible on it’s own, combined with helium-neon laser Nd:Yag LaserGreat CoagulationDeep penetration/surroun ding tissue damage Able to go through liquids, can be used in fluid filled areas

16. Additional Management Dexamethasone Possible Post-op Intubation Racemic Epi PPI H2 Blocker

17. Subglottic Stenosis Aquired Subglottic Stenosis From prolonged intubation or high pressure on the tracheal mucosa Congenital Subglottic Stenosis Cricoid diameter less than 3.5mm Result of malformation of the cricoid cartilage

18. Vocal Cord Paralysis Inspiratory or biphasic stridor, weak cry Causes Birth trauma Central (Arnold-Chiari, Brainstem compression) neurologic diseases Thoracic disease or procedures (PDA ligation, aortic arch surgery)

19. Posterior glottic web

20. Anterior Laryngeal Webs

21. Laryngotracheal Cleft

23. ENT Pathology and associated Co-morbidities

24. Sources Messer A. Congenital Disorders of the Larynx. Cummings Otolaryngology. 5 th Ed. 2010. 2866-75. Boudewyns A, Claes J, Van de Heyning P. An approach to stridor in infants and children. Eur J Pediatr 2010: 169; 135-141. Richter G, Thompson D. The Surgical Management of Laryngomalacia. Otolaryngol Clin N Am 2008: 41: 837-64.