Tracheomalacia

What is Tracheomalacia?

This is a medical condition that is characterized by weakness of your trachea. Tracheomalacia is made of two words; trach, which refers to your trachea, and malacia, which means flexible and soft. Your trachea is made to contract and expand as you breathe but if it is or becomes weakened, the cartilage will not be as strong and the tube may also not be as flexible. These can make it hard for you to breathe. You can also have difficulty breathing and could be at risk to develop aspiration pneumonia. This is when your lungs could become infected due to inhaling food. You may even experience complete airway collapse when you breathe out and your trachea will contract but will not be able to hold itself open as it normally would

If a baby is born with tracheomalacia, it is important to know that it can accompany other abnormalities during their developmental years. They should be watched closely for any signs of other problems. Some of these problems can include developmental delays, gastroesophageal reflux, or heart defects.

What is your trachea?

Also known as your windpipe, it is the tube which connect your mouth and nose to your lungs and is an vital part of your respiratory system. When you breathe in the air goes into your lungs through your trachea. Your trachea is made of ligaments and cartilage. It is found at the front of neck and starts at the bottom part of your larynx, also referred to as your voice box. It continues downwards into your lungs and then it branches off to your left and right bronchi, which are the main passageways into your lungs. Your trachea measure sixteen to eighteen millimeters in diameter and ten to twelve centimeters in length. It is made of sixteen to twenty C-shaped rings of cartilage. They are connected by your ligaments with a cilia-lined mucus membrane.

Types of Tracheomalacia

There are two types of tracheomalacia, which are:

• Congenital — this occurs during fetal development and is the most common form.
• Acquired — this happens after birth

Symptoms

• Rattling or high pitched breathing
• Breathing noises that could change when you change positions while asleep and awake but may improve with sleep
• Breathing problems that become worse when you cough, when the baby feeds, have an upper respiratory infection, or crying

Tracheomalacia Picture – Normal vs Tracheomalacia

Causes of Tracheomalacia

• Congenital — this is caused by underdeveloped cartilage in their trachea. Instead of the walls of the trachea being rigid they are floppy. Because the trachea is the main airway they will start to have breathing difficulties soon after they are born.
• Acquired — this type can be the result of abnormal blood vessels, which put pressure on their trachea and cause it to break down. It can also be from an infection of their trachea. Other causes can include certain surgeries or prolonged use of a ventilator, which could cause cartilage breakdown as a complication.

Diagnosis

Before any treatment is done your physician will run some diagnostic tests along with medical imaging to learn about the condition of your trachea so they can use an appropriate treatment plan. They will also do a physical examination, which can confirm the symptoms. Doing a chest x-ray it could should the narrowing of your trachea when breathing. Many times your physician will send you to see an otolaryngologist, who is a physician who specializes in the diagnosis and treatment of diseases of your neck and head, especially those that involve your ears, nose, and throat. This specialist will do a laryngoscopy, which will allow them to see the airway structure and give a definitive diagnosis. Other tests that may be done can include:

• Barium swallow
• Airway fluoroscopy
• Bronchoscopy, which is when they put a small camera down your throat to see the lungs and airway
• CT scan
• Lung function tests

Treatment for Tracheomalacia

• Congenital — the treatment will normally rely on supporting the child during early childhood development so the cartilage in their trachea has a chance to grow. This includes careful feedings, humidified air, and if there are any infections they may need antibiotics. Generally it will go away on its own by the age of eighteen to twenty-four months. They will need to be closely monitored if they do have a respiratory infection. There are some infants that will require surgery to correct the problem but this is rarely needed.
• Acquired — to help you breathe easier and more comfortably a continuous positive airway pressure machine (CPAP) may be used. The CPAP machine will also help to avoid periods of apnea, which are brief pauses in your breathing patterns or you may even stop breathing altogether for a few seconds and then resume breathing. You may even have to have a stent put in to hold your trachea open.