Tracheomalacia (Primary and Secondary)

What Is Tracheomalacia?

Tracheomalacia is characterized by collapse of the walls of the windpipe (trachea). This can be due to intrinsic softness of the walls of the trachea or due to compression from something outside of the trachea. The collapse can involve only a short segment of the windpipe, or can involve the entire trachea. If the collapse extends past the point where the trachea divides into the two lungs, it is called Bronchomalacia.

If the collapse is only due to weakness of the cartilage in the tracheal wall, it is called primary tracheomalacia. If it is due to compression by a structure outside of the windpipe, it is called secondary tracheomalacia. Compression may be due to an abnormal position or shape of a large blood vessel in the chest, from the heart, or from other structures in the chest. It is also common to find tracheomalacia in an infant who has had a Tracheoesophageal Fistula (abnormal opening between the windpipe and the esophagus).

What Are the Signs and Symptoms of Tracheomalacia?

  • Noisy breathing (Stridor) on expiration. This is sometimes called a “tracheal wheeze”
  • Expiratory stridor may improve in different positions, particularly during “tummy time”.
  • High pitched, harsh cough
  • Rattling noise when breathing. This can sometimes be felt in the chest or back
  • Breathing problems may worsen with coughing, crying, feeding, or with a cold.

How Is Tracheomalacia Diagnosed?

Tracheomalacia can be suspected based on history and physical exam. It can sometimes be seen with certain types of X-rays, including CT scan of the Chest or Airway Fluoroscopy. Diagnosis is confirmed with Direct Laryngoscopy/Bronchoscopy and/ or with Flexible Bronchoscopy.

If a diagnosis of tracheomalacia is made, your doctor may recommend other studies or procedures to help determine the cause of the problem or to help define treatment options.

How Is Tracheomalacia Treated?

In most cases, symptoms of tracheomalacia will gradually improve as he/ she grows and the cartilage in the walls of the trachea becomes stronger. It may take years until the symptoms have completely resolved. A humidifier may make breathing easier for your child during this time. In some cases, your doctor may recommend certain medications to decrease mucous in the airway or to decrease inflammation in the airway. It is important to realize that a cough or cold that causes only mild symptoms for another child, may cause severe symptoms in a child with tracheomalacia. He or she may require more aggressive treatment including medications, or may even require admission to the hospital if symptoms are severe.

If the tracheomalacia is due to a structure outside of the windpipe compressing it, your physician may recommend additional management, including, at times, surgical management. At Nationwide Children’s Hospital, Pediatric Otolaryngologists, Pediatric Pulmonologists, Pediatric Cardiologists, and Pediatric Cardiothoracic Surgeons may all be involved in this type of care.

When Should I Be Concerned If My Child Has Tracheomalacia?

It can be difficult for a parent or family member to discern the severity of a breathing problem when a child has tracheomalacia. If you are concerned, we urge you to seek medical evaluation immediately. If your child is showing signs of illness, consider consulting your physician for additional treatment recommendations.

In particular, signs that indicate more severe conditions include: irritability, poor feeding, pulling in of the skin at the collar bone, between the ribs, or under the ribs, flaring of the nose, increasing effort to breathe, and poor weight gain or weight loss, especially in infants.

Symptoms that should trigger emergent evaluation include: pauses in the breathing, color change of the skin (particularly if the lips, face, or hands are turning blue), appearing lethargic or tired, or any other sudden change from a child’s normal breathing pattern. If any of these or other concerning signs develop, please seek immediate medical attention.