Laryngeal Cleft: Causes, Symptoms, and Treatment
Medically reviewed by Harsha Moole, MD, Internal Medicine. Last reviewed: October 23, 2026.
What kind of doctor treats Laryngeal Cleft?
A pediatric otolaryngologist, an ear, nose, and throat doctor for children, usually treats a laryngeal cleft. Care often involves a team, including lung, stomach, and speech specialists. A direct primary care or concierge doctor can be a first stop for an evaluation and can refer you to a specialist when needed.
What is a laryngeal cleft?
A laryngeal cleft is an abnormal connection between the airway and the esophagus, the tube that moves food to the stomach. A baby is born with it. Because of this opening, food and liquid can enter the airway from the esophagus. Air can also enter the esophagus from the airway. This causes problems with breathing and swallowing.
The mildest form, type I, is a deep groove that reaches up to the vocal cords. It is the most common type. Type IV is the most severe form and happens less often. A cleft that reaches the windpipe is also called a laryngotracheoesophageal cleft.
Symptoms
Symptoms usually appear within the first few months of life. They mostly involve trouble eating and breathing. Common signs include:
- Gagging, choking, or coughing during feeding.
- Trouble gaining weight.
- A long-lasting cough and frequent lung infections.
- Noisy breathing, such as stridor, a high-pitched gasping sound heard when breathing in.
- Wheezing, a high-pitched musical sound heard when breathing out.
- Hoarseness and acid reflux.
Signs often start in the first few days of life if the cleft is severe enough to affect feeding and breathing. A milder cleft may not be found until years later.
Causes and who gets it
The cause is unknown. Normally, the airway and the esophagus separate completely while a baby grows in the womb, so they are not connected. If that split is not finished, a connection remains. Laryngeal clefts are estimated to occur in 1 out of every 10,000 to 20,000 births.
A cleft can happen alone. It can also be part of a syndrome, a group of health problems that occur together. Examples include CHARGE syndrome and VACTERL association.
How doctors diagnose it
A doctor may suspect a cleft from a child's signs and symptoms. A modified barium swallow study can help. The child drinks a liquid mixed with barium, a white powder that shows up on x-rays. X-rays then show whether any liquid leaks from the esophagus into the airway. Barium is not harmful to the child's health.
The preferred way to diagnose a cleft is a rigid laryngoscopy and bronchoscopy. The doctor uses a camera with a light to look inside the voice box and windpipe. This is usually done under general anesthesia, which means the child is asleep, in an operating room. The doctor measures the connection to learn the type and how severe it is.
After diagnosis, a team of doctors usually cares for the child. It can include a lung doctor, a stomach doctor, an ear, nose, and throat doctor, a speech pathologist, and a geneticist. If the child has other health problems, genetic testing may be suggested.
Treatment
The main treatment is surgery to close the connection between the airway and the esophagus. The surgeon closes the cleft with stitches. Children with milder forms may not need surgery. For a type I cleft, doctors may watch the child, use an injection, or do surgery, depending on several factors.
Surgery can be done through the mouth, which is called an endoscopic repair. It can also be done through the neck, which is called an open repair. Endoscopic repair is preferred for mild clefts. Open repair is often needed for more severe clefts, such as types III and IV.
Some children also need a tracheostomy, a breathing tube placed in the neck, or a gastrostomy tube, a feeding tube placed in the stomach.
When to see a doctor
Talk to your child's doctor if your baby often gags, chokes, or coughs during feeding, has trouble gaining weight, or has noisy breathing or repeated lung infections.
Call 911 or go to the emergency room if a child has severe trouble breathing, bluish or grey skin, or is choking and cannot breathe.
How a direct primary care or concierge doctor fits in
A direct primary care doctor charges a flat monthly fee instead of billing insurance, while a concierge doctor usually charges more and often works alongside insurance. Such a doctor can review your child's symptoms, help arrange a visit with a pediatric ear, nose, and throat doctor, and help keep the many specialists on the care team working together.
Common questions
Can a laryngeal cleft be fixed?
Yes, surgery is the main treatment. The surgeon closes the connection between the airway and the esophagus with stitches. Children with milder forms may not need surgery.
What causes a laryngeal cleft?
The cause is unknown. A laryngeal cleft is present at birth. It happens when the airway and the esophagus do not fully separate before birth.
How common is a laryngeal cleft?
It is rare. Laryngeal clefts are estimated to occur in 1 out of every 10,000 to 20,000 births.
Can a laryngeal cleft be found later in life?
Yes, a milder cleft may not be found until years later. Most children are diagnosed in the first two years of life.
Sources
- National Organization for Rare Disorders (NORD) - Laryngotracheoesophageal Cleft
- National Library of Medicine (PMC) - Type 1 laryngeal cleft management
Medical Disclaimer
This content is for general educational and informational purposes only and is not medical advice. It is not a substitute for professional medical advice, diagnosis, or treatment, and reading it does not create a doctor-patient relationship. Always seek the advice of your physician or another qualified health provider with any questions about a medical condition, and never disregard or delay seeking professional advice because of something you read here. If you think you may have a medical emergency, call 911 (or your local emergency number) immediately.
