Tracheomalacia

Tracheomalacia is a structural abnormality of the tracheal (windpipe) cartilage resulting in the collapse of the wall of the trachea which obstructs the airway.

There are three types of tracheomalacia:

  • Type I is congenital (hereditary) and may be associated with abnormalities in the trachea.
  • Type II may present after prolonged pressure on the trachea.
  • Type III is acquired through chronic infections in the trachea, prolonged intubation or polychondritis (inflammation of the cartilage in the trachea).
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Symptoms

Patients with tracheomalacia may find it difficult to swallow food. Symptoms of tracheomalacia include:

  • Shortness of breath.
  • Chronic cough, with or without blood.
  • Hoarseness
  • Recurring respiratory tract infections.

Causes and Risk Factors

Tracheomalacia is rare. In the case of Type I tracheomalacia, the risk factor is immaturity of the tracheal cartilage. Often, as the infant grows, the cartilage structure improves and the condition resolves on its own. Tracheomalacia can also be associated with developmental disorders such as cardiovascular defects, esophageal diseases and gastroesophageal reflux (GERD).

Adults may be at risk for tracheomalacia due to a weakening of the muscles surrounding the trachea as they age. This may create an inability to keep the trachea rigid for normal breathing. Other risk factors include:

  • Prolonged intubation, especially in patients who have had a tracheostomy, the construction of an artificial opening through the neck into the trachea, to relieve breathing difficulties.
  • Chronic infection and inflammation.
  • Chronic obstructive pulmonary disease (COPD).
  • Injury to the trachea.
  • Tumors, benign or malignant, compressing the trachea.
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Diagnosis

In some cases, it is possible to see the abnormal structure of the trachea. Frequently, tracheomalacia is found during incidental imaging of the chest. Some diagnostic tests include:

  • X-ray of the chest and neck.
  • A computed tomography (CT) scan, with inhaling and exhaling. Inhaling alone may not show the collapse of the trachea, which is more visible upon exhaling.
  • Endoscopy, where a tube with a camera is inserted in the airway.
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Treatments

The physicians at the Women's Guild Lung Institute are experienced in treating tracheomalacia and will work with you to find the best treatment option for your situation. Noninvasive medical management is typically the first course of treatment, particularly with infants. Parents should humidify the child’s environment with a nebulizer or humidifier and feed the infant slowly and carefully.

Some patients respond to chest therapy, which includes draining the secretions that may accumulate in the trachea and lungs, deep breathing exercises and tapping or vibrating the chest to break up mucous. Some patients respond to positive pressure ventilation, a face mask with a valve bag, to assist with breathing.

If medical management doesn’t provide relief, surgery may be required. A short term solution may be a tracheostomy, which consists of making an incision in the neck, opening a direct airway to the lungs with a tube, bypassing the nose and mouth.

Stenting is another surgical option, which includes inserting a small tube of metal or high-density polyethylene or polypropylene mesh into the trachea, which is then surgically attached to the tracheal wall.