An unusual case of laryngomalacia presenting as asthma refractory to therapy

Rajiv Arora, Thomas J. Gal, Larry L. Hagan

Research output: Contribution to journalArticlepeer-review

8 Scopus citations

Abstract

Background: Laryngomalacia is the most common cause of stridor in infants, but few reports exist of clinically relevant laryngomalacia in adults. Objective: To present and discuss an unusual late presentation of laryngomalacia and its significance in the evaluation and management of asthma. Methods: An 18-year-old woman presented to an academic medical center with symptoms of "wheezing" on inspiration and exertion, with relatively normal spirometric findings. She was clinically diagnosed as having asthma at the age of 13 years, but her symptoms were poorly controlled by maximal medical therapy. Further evaluation with rhinolaryngoscopy demonstrated laryngomalacia characterized by redundant soft tissue overlying the right arytenoid cartilage and aryepiglottic fold. Results: The patient demonstrated positive bronchoprovocation, with a 33% decrease in forced expiratory volume in 1 second after the administration of histamine, 1 mg/mL. However, with the otolaryngology evaluation, it was determined that her laryngeal findings were clinically significant. She subsequently underwent operative laryngoscopy with carbon dioxide laser excision of the laryngeal abnormality, resulting in improvement in her symptoms and a marked decrease in her need for asthma medication. Conclusions: We report an unusual case of laryngomalacia presenting as asthma that was successfully treated with laser surgical excision. This case emphasizes the necessity of differentiating classic wheezing from stridor and upper airway obstruction.

Original languageEnglish
Pages (from-to)607-611
Number of pages5
JournalAnnals of Allergy, Asthma and Immunology
Volume95
Issue number6
DOIs
StatePublished - Dec 2005

ASJC Scopus subject areas

  • Immunology and Allergy
  • Immunology
  • Pulmonary and Respiratory Medicine

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