A 10-month-old child presents with an abnormal inspiratory sound; mother complaints that the sound increases with cry, and decreases when the child sleeps in prone position. What would be the probable diagnosis?
First, I need to think about causes of inspiratory stridor in infants. Stridor is usually due to upper airway obstruction. Common conditions include laryngomalacia, which is the most common cause in infants. Laryngomalacia occurs when the soft tissues around the larynx collapse inward during inspiration, causing a high-pitched sound. It often improves when the child is in a prone position because this reduces the collapse. Also, crying can exacerbate the stridor because of increased intrathoracic pressure or the action of crying itself.
Other differentials might include subglottic stenosis, but that's less common and might present with a more constant stridor. Tracheomalacia can cause similar symptoms but the stridor is usually biphasic. Laryngeal papillomatosis is another possibility, but it's rare and often associated with a history of maternal genital warts (HPV transmission).
The options given are missing, but based on standard MCQs, the answer is likely laryngomalacia. The other options would be incorrect because they don't fit the presentation. For example, croup (viral laryngotracheobronchitis) typically presents with a barky cough and stridor that worsens at night, but the positional improvement with prone position is more characteristic of laryngomalacia.
Clinical pearl: Remember that laryngomalacia is a congenital condition and often improves with age. The key features are the inspiratory stridor that worsens with crying and improves in prone position. Management is usually conservative unless severe.
**Core Concept**
Inspiratory stridor in infants is most commonly caused by **laryngomalacia**, a congenital condition where floppy laryngeal tissues collapse during inspiration. Key features include positional improvement (e.g., prone position) and exacerbation with crying.
**Why the Correct Answer is Right**
Laryngomalacia presents with **inspiratory stridor** due to supraglottic tissue collapse. Crying increases intrathoracic pressure, worsening the stridor, while the prone position reduces tissue collapse by altering laryngeal mechanics. It is the **most common cause of stridor in infants** and typically improves with age.
**Why Each Wrong Option is Incorrect**
**Option A:** *Subglottic stenosis* causes fixed airway narrowing, presenting with biphasic stridor and no positional improvement.
**Option B:** *Tracheomalacia* involves tracheal weakness, leading to expiratory or biphasic stridor, not inspiratory.
**Option C:** *Laryngeal papillomatosis* is rare, often associated with maternal HPV history, and causes hoarseness with progressive stridor.
**Option D:** *Croup* (viral laryngotracheitis) presents with **barky cough**, fever, and stridor worsening at night, not positional relief.
**Clinical Pearl**
Remember the **"3 Cs" of laryngomalacia**: **C**ongenital, **C