Laryngomalacia and inspiratory obstruction in later childhood.

Pulmonary function and symptoms were reviewed in 20 children in whom laryngomalacia had been diagnosed by direct laryngoscopy in infancy. Most children developed stridor in the first 2 weeks, but 3 children did not develop it until age 3 months. The mean duration of stridor was 4 years 2 months, with a range of 4 months to 12 years 7 months. Six children had marked posseting as infants. Airway dynamics were assessed by flow volume loops. All except one had normal expiratory flow volume curves. Inspiratory abnormalities were detected in 7 children; 6 were assessed as having variable extrathoracic inspiratory obstructions and 1 had a fixed obstruction consistent with subglottic stenosis. The mean ratios of maximal inspiratory flow at 50% of vital capacity divided by forced vital capacity in the laryngomalacia and control groups differed significantly, as did the mean ratios of maximal expiratory flow to maximal inspiratory flow at 50% of forced vital capacity. Laryngomalacia is not necessarily a benign disorder of limited duration; there may be persisting inspiratory obstruction in later childhood.