Tracheomalacia

What is tracheomalacia?

Tracheomalacia is a condition that happens when the cartilage in your trachea (windpipe) is weak or floppy. As a result, the walls of your windpipe collapse or fall in, leading to a range of breathing issues.

There are two kinds of tracheomalacia:

• Congenital tracheomalacia: Affecting newborns, congenital tracheomalacia happens when their windpipe doesn’t form properly during fetal development. (Congenital means that you’re born with the condition.)
• Acquired tracheomalacia: Although it’s very uncommon, acquired tracheomalacia can occur at any age. It happens when your windpipe begins to break down or is damaged as a result of injury, surgery or prolonged intubation (mechanical breathing).

How common is tracheomalacia?

Congenital tracheomalacia is somewhat rare. Even so, it’s the most common congenital (birth) defect affecting the windpipe. Approximately 1 in 2,100 children are born with the condition.

Acquired tracheomalacia (which can occur at any age) is also very uncommon.

What are the symptoms of tracheomalacia?

Common tracheomalacia symptoms include:

• High-pitched or noisy breathing (stridor), which may improve with certain sleeping positions.
• Frequent, chronic coughing.
• Wheezing.
• Breathing issues that get worse when feeding, crying or coughing.
• Frequent airway infections such as pneumonia or bronchitis.
• Shortness of breath (dyspnea).
• Difficulty swallowing (dysphagia).

More severe tracheomalacia symptoms may include:

• A temporary halt in breathing, particularly when crying.
• Choking during feeding.
• Cyanosis (a condition where your skin turns blue from lack of oxygen).

What causes congenital tracheomalacia?

Congenital tracheomalacia happens when the cartilage in your baby’s windpipe doesn’t develop properly. The walls of your child’s windpipe are floppy instead of rigid.

Tracheomalacia causes in adults

Acquired tracheomalacia occurs most often in adults, though it can occur at any age. Acquired tracheomalacia may occur as a result of:

• Damage due to surgery or other medical procedures.
• Tracheostomy, or long-term use of a breathing tube.
• Chronic upper respiratory infections, such as bronchitis.
• Chronic acid reflux (GERD).
• Emphysema.
• Polychondritis (inflammation of the cartilage in your windpipe).

How is tracheomalacia diagnosed?

A healthcare provider will perform a physical examination and ask about symptoms. If they suspect tracheomalacia, they may perform a laryngoscopy in a clinic, but a bronchoscopy under general anesthesia may be necessary to confirm this diagnosis. During this procedure, your provider will use a thin, flexible or rigid tube with a light and camera to look at your or your child’s windpipe.

Other diagnostic tests may include:

• Chest X-ray.
• CT (computed tomography) scan.
• MRI (magnetic resonance imaging).
• Barium swallow (esophagram).
• Airway fluoroscopy.
• Lung function tests.

How do you fix tracheomalacia?

It depends on the type of tracheomalacia and the severity of the condition:

Tracheomalacia in infants (congenital tracheomalacia)

In many cases, infants born with tracheomalacia improve over time — usually by 24 months of age. To manage your baby’s tracheomalacia, your healthcare provider may recommend:

• Humidified air.
• Medication to reduce mucus in your baby’s windpipe.
• Chest physical therapy.
• Continuous positive airway pressure (CPAP).

If your baby has severe tracheomalacia, your healthcare provider may recommend surgery. But surgery is rarely necessary.

Tracheomalacia in adults (acquired tracheomalacia)

Adults with tracheomalacia can often manage symptoms with continuous positive airway pressure (CPAP). Ask your healthcare provider if this type of therapy is right for you.

Most of the time, surgery isn’t necessary. But if you have severe tracheomalacia, a surgeon can place a stent (a hollow tube) to keep your airway open.

How can I reduce my risk for tracheomalacia?

People are either born with tracheomalacia or they acquire it following certain medical procedures, infections or injuries. As a result, there’s nothing you can do to reduce your risk for this condition. But you can successfully manage tracheomalacia with the help of your healthcare provider.

What’s the outlook for people with tracheomalacia?

Tracheomalacia is very treatable. Most people go on to live healthy lives with no complications.

Treatment isn’t always necessary. Congenital tracheomalacia usually improves on its own within the first 24 months of life. In some cases, your baby may need additional treatments and/or surgery.

People with tracheomalacia (congenital and acquired) will need close monitoring if they develop upper respiratory infections. Even minor colds can cause serious issues for people with tracheomalacia. Your healthcare provider may recommend treatments or medications to manage your symptoms.

When should I see my healthcare provider?

Schedule an appointment with your healthcare provider if your baby shows symptoms of tracheomalacia, such as noisy breathing, frequent coughing, choking during feeding or blue spells (cyanosis).

If you think you or a loved one could have acquired tracheomalacia, schedule an appointment with a healthcare provider right away. Symptoms include difficulty breathing, exercise intolerance and prolonged respiratory infections. Your provider can confirm the diagnosis and recommend the appropriate treatment.

What questions should I ask my doctor?

If a healthcare provider diagnoses you or your baby with tracheomalacia, here are some questions you may want to ask:

• How severe is the condition?
• What caused the condition?
• What treatment do you recommend?
• Will surgery be necessary?
• What can I do to ease symptoms?
• How soon do I need treatment?

Does tracheomalacia go away?

Babies born with tracheomalacia often improve over the first 24 months of life. But babies with severe tracheomalacia, or people who acquired the condition later in life, may need treatment.

Is tracheomalacia life-threatening?

Tracheomalacia ranges in severity, from mild to life-threatening. The condition is curable with treatment. People with severe tracheomalacia will likely need surgery.

A note from Cleveland Clinic

Tracheomalacia is an uncommon condition that causes your windpipe to fall in on itself. Ranging from mild to severe, tracheomalacia can lead to a number of issues, including noisy breathing, frequent coughing and choking during feeding (infants). In severe cases, tracheomalacia may be life-threatening, but it’s curable with treatment. If you or your child develop tracheomalacia symptoms, schedule an appointment with your healthcare provider. They can determine the severity of your condition and help find a treatment option that works for you.