An unusual case of laryngomalacia presenting as asthma refractory to therapy.
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.
Arora
Rajiv
R
Department of Allergy/Immunology, Wilford Hall Medical Center, Lackland AFB, Texas 78236-5300, USA. rajiv.arora@us.army.mil
Gal
Thomas J
TJ
Hagan
Larry L
LL
D000293:Adolescent; D001249:Asthma / Q000150:complications* / Q000188:drug therapy*; D005260:Female; D006801:Humans; D007818:Laryngeal Diseases / Q000150:complications* / Q000473:pathology / Q000601:surgery; D007828:Laryngoscopy; D012135:Respiratory Sounds / Q000209:etiology