**Question:** True about laryngomalacia - a) Most common cause of congenital stridor; b) Inspiratory stridor normal on crying; c) Prone position worsens condition; d) 50% of patients requires surgery; e) Omega shaped epiglottis

**Core Concept:** Laryngomalacia is a common congenital disorder characterized by the collapse of the larynx, particularly during inhalation, leading to stridor and breathing difficulties in infants. The omega-shaped epiglottis contributes to the obstruction.

**Why the Correct Answer is Right:**

a) Laryngomalacia is a common cause of congenital stridor, which is high-pitched breathing noise heard during breathing. The collapse of the larynx during inhalation is the primary mechanism leading to stridor.

b) Inspiratory stridor is normal in laryngomalacia as it is the stridor that occurs during inhalation due to the collapse of the larynx. Exhalatory stridor would be a different condition.

c) Prone position (lying face down) worsens laryngomalacia symptoms as it increases the pressure in the chest cavity, causing more compression of the larynx.

d) Although some patients may require surgery (tracheostomy or laryngoplasty), the majority of cases improve on their own as the child grows and the larynx and airway structures develop.

e) An omega-shaped epiglottis is a characteristic feature of laryngomalacia, which contributes to the obstruction and stridor in infants.

**Why Each Wrong Option is Incorrect:**

a) This option is incorrect because laryngomalacia is not the most common cause of stridor in infants, and there are other congenital respiratory conditions that may present similarly.

b) Inspiratory stridor due to laryngomalacia is normal as it is the stridor that occurs during inhalation due to the collapse of the larynx. Exhalatory stridor would be a different condition.

c) While prone positioning may worsen symptoms in severe or complicated cases, in most cases, laryngomalacia improves as the child grows and the larynx and airway structures develop.

d) While surgery is required in some cases, the majority of laryngomalacia cases improve without surgical intervention.

e) While an omega-shaped epiglottis is a characteristic feature of laryngomalacia, it is not the sole cause of stridor and other congenital respiratory disorders may present similarly.

**Clinical Pearls:**

1. Laryngomalacia can be distinguished from other respiratory conditions by evaluating the stridor pattern (inhalatory vs. exhalatory) and the age of onset (congenital vs. acquired).
2. Prone positioning might worsen symptoms in severe or complicated cases, but typically, laryngomalacia improves as the child grows and airway structures develop.
3. Surgery is required in some cases, but the majority of laryngomalacia cases improve without surgical intervention.
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