Laryngeal web is a rare condition in which your child’s windpipe is partially constricted, or narrowed, making it difficult to breathe normally causing frequent shortness of breath and other symptoms. The larynx (voice box) contains web-like tissue that limits the volume of air flowing in and out of the windpipe. The web may be very thin or thicker, which will determine the severity of your child’s breathing limitation and may also impact the appropriate treatment method.

Causes

Laryngeal web is often a congenital defect, which means it is present from birth.  In some cases, laryngeal webs are acquired, often resulting from long-term intubation.

Signs and Symptoms

The most common symptom is frequent shortness of breath and stridor, which includes a vibrating sound as if something is partially blocking the windpipe. Poor feeding and weak cry have been associated with these webs.

Other symptoms that may occur include:

• Wheezing
• Coughing
• Frequent chest infections

Some children also tend to raise their head or stretch the neck to open the airway as much as possible.

Diagnosis

Laryngeal web often shows similar symptoms to asthma, and it can be initially misdiagnosed.

When asthma medications or other treatments do not improve your child’s condition (often called refractory asthma), it is important to inform your doctor.

To properly diagnose tracheal web, the following diagnostic procedures may be used:

• Microlaryngoscopy: A microlaryngoscopy, or microscopic laryngoscopy, uses a small, flexible telescope to look in the airway for signs of a tracheal web or partial obstruction.
• CT scan: In some cases, it may be necessary to get a picture of the chest to look for airway abnormalities.

Treatment

The goal of treatment is to remove the obstruction by breaking the web, allowing the airway to open up to its full capacity. Depending on the severity of the web, your surgeon may accomplish this by dilating the trachea and using a laser or cutting instrument to break the web. In some cases of a thicker web, your surgeon may recommend an open surgical approach to expand the airway.

Dilation

The surgeon will take your child to the operating room and place a small balloon in the airway to widen or break the web. This may need to be repeated to prevent reformation of the web by scar tissue.

Surgery

For some webs the correct treatment is an open surgical procedure called a laryngofissure, opening into the larynx, generally through the midline incision through the neck.

Recovery

If dilation is needed your child will spend one to two nights in the hospital until their breathing is safe. If an open neck procedure is needed, then one to two weeks is usually needed in the hospital following the operation.

Long-Term Outlook

Prognosis is good with a normal lifespan. The only noticeable long-term symptoms may be a hoarse or rough voice.

Call Your Doctor If:

Your child experiences:

• Excessive shortness of breath during exercise or at rest
• Frequent chest infections
• Continued noisy breathing