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You are counseling the mother of a 3-month-old baby. The mother is concerned because the infant has noisy breathing on inspiration, especially when agitated. You identify the sound as high-pitched stridor, consistent with laryngomalacia. What is the most accurate statement regarding laryngomalacia?

A. The condition will require surgery.

B. Most children outgrow laryngomalacia around 12 to 18 months of age.

C. The noise is worse when the child is prone or upright and better when supine.

D. The condition is commonly associated with failure to thrive.

E. The condition has a bimodal age distribution and also commonly presents during adolescence.

Answer: B

Laryngomalacia is the most common cause of stridor in newborns. Its exact pathogenesis is unknown. Laryngoscopy demonstrates an omega shape of the epiglottis, and the aryepiglottic folds and false vocal cords are drawn into the laryngeal lumen. The resulting narrowing leads to high-pitched stridor, which is worse when the infant is agitated, feeding, or in the supine position. The stridor often worsens with severity over time.

In the majority of cases, laryngomalacia is benign and resolves around 12 to 18 months of age. More severe cases of laryngomalacia can result in poor growth and/or cyanotic or apneic events. In those rarer patients, supraglottoplasty (surgical trimming of the aryepiglottic folds) is recommended.

Late one evening, the mother of a 3-year-old boy calls the after-hours provider on call and states that she saw her son put something in his left nostril 30 minutes ago. He was recently playing with a battery-operated toy, and the mother suspects that he most likely put a small round battery in his nose. He has left-sided rhinorrhea, no bleeding, no respiratory distress, and no fever or pain. She tried to remove the item with a cotton-tip applicator but was unsuccessful. What do you advise the mother to do?

A. Come to the outpatient clinic for the first appointment tomorrow morning to remove the nasal foreign body.

B. Go to the emergency department (ED) within the next 12 hours to remove the nasal foreign body.

C. Provide reassurance that the nasal foreign body will fall out on its own within 24 hours.

D. Go to the ED immediately for removal of the nasal foreign body.

E. Arrange an ear, nose, and throat (ENT) appointment for tomorrow to remove ...

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