An abnormal laxity or softening of laryngeal tissues, most often seen during inspiration as floppiness and indrawing of the arytenoid mucosa or aryepiglottic cords. Sometimes the epiglottis acts like a sail and, caught by the inspiratory air, flips downward to partially cover the laryngeal vestibule. Laryngomalacia may be the result of structural weakness, especially in premature infants; it can also be “induced” or “allowed” in older children and adults of all ages, as one type of nonorganic breathing disorder.

Laryngomalacia Due to Breathing Tube Injury

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Breathing tube injury (1 of 4)

After a life-threatening illness including weeks in an ICU on a ventilator (breathing tube involved), this person underwent tracheotomy. Here, the old breathing tube injury of the vocal cords is clearly seen and explains a very hoarse voice. Arrows point out divots of tissue loss from pressure necrosis. Dotted lines indicate where the margins of the vocal cords would be if uninjured.

Synechia and lateral scarring (2 of 4)

Viewing from barely below the vocal cords, the white tracheotomy tube enters the airway in the distance, and a synechia (s) and lateral scarring (sc) are seen in the foreground.

Damage from tracheotomy tube (3 of 4)

Viewing from deeper into the subglottis while the patient exhales with trach tube plugged, there is “blow-by” dark room around the #6 tracheotomy tube. The diagonal line, upper right, indicates junction between membranous (M) and cartilaginous (C) trachea.

Indrawing of the cartilaginous wall (4 of 4)

When she inhales with tracheotomy tube plugged, the walls of the trachea collapse inward, and the patient cannot fill her lungs. Most noteworthy is the indrawing of the cartilaginous wall (arrow at C). Tracheal narrowing for exhalation can be managed with expiratory straw breathing. Collapse of this magnitude during inspiration implies the need for repair (resection of the bad segment and re-anastomosis).