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.
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