Tracheomalacia

Definition

Tracheomalacia is a weakness and floppiness of the walls of the trachea (main airway). There are three types of tracheomalacia. One type is congenital (present at birth); the others are acquired, meaning that the trachea is normal at birth but becomes floppy later in life.

Causes

Tracheomalacia in a newborn occurs when the cartilage in the trachea has not developed properly. This causes the wall of the trachea to be floppy rather than relatively rigid, as it is supposed to be. Breathing difficulties associated with congenital tracheomalacia (also called type 1) begin soon after birth.

Other types of tracheomalacia occur due to degeneration of previously normal cartilage in the wall of the trachea. This can happen when something outside the trachea causes pressure on the airway (for example, an abnormality of the blood vessels surrounding the trachea or a tumor in the neck or throat). This is called type 2 tracheomalacia. Breakdown of the cartilage in the trachea can also result from prolonged intubation or chronic infections involving the trachea. This is called type 3 tracheomalacia.

All three types of tracheomalacia are very uncommon.

Symptoms

• High-pitched breathing ( stridor) and rattling, noisy breaths
• Breathing problems that get worse with coughing, crying, feeding (in the case of infants) or upper respiratory infections
• Breathing noises that may change with position and improve during sleep

Exams and Tests

A doctor's examination confirms the symptoms. A chest x-ray may show narrowing of the trachea when exhaling. Even if the x-ray is normal, it is needed to rule out other problems.

A definitive diagnosis is obtained by laryngoscopy, which is performed by a otolaryngologist (ear, nose, and throat doctor, or ENT). This allows the airway anatomy to be seen and helps determine the extent of tracheomalacia.

Other tests that may be performed include airway fluoroscopy, barium swallow, bronchoscopy, lung function tests, and magnetic resonance imaging (MRI).

Treatment

People with tracheomalacia must be monitored closely when they have respiratory infections. Most infants respond well to humidified air, physical therapy, careful feedings, and antibiotics for infections.

Continuous positive airway pressure (CPAP) may be necessary for adults with respiratory distress. Rarely, surgery is needed. In the case of acquired tracheomalacia, the placement of a stent to hold the airway open may be necessary.

Outlook (Prognosis)

Congenital tracheomalacia generally resolves on its own by the age of 18-24 months. As the tracheal cartilage strengthens and the trachea grows, the noisy respirations and breathing difficulties gradually stop.

Possible Complications

Babies born with tracheomalacia may have other congenital abnormalities such as heart defects, developmental delay, or gastroesophageal reflux.

Aspiration pneumonia

When to Contact a Medical Professional

Call your health care provider if you or your child breathe in an abnormal manner. It can become an urgent or emergency condition.