Tracheomalacia: Definition, Symptoms, Causes, Diagnosis, Treatment, Prognosis and Prevention

This condition is generally friendly and appears at birth.

It is a rare condition in which the cartilage that makes up the trachea walls, which are usually rigid, does not develop properly in the uterus, leaving them weak and flabby or flexible.

The weakened walls are likely to collapse and cause airway obstruction. This leads to breathing problems.

It is possible to acquire the condition later in life; this usually occurs when a person has been intubated for a long time, has had a recurrent inflammation, or by an infection of the trachea.

Tracheomalacia causes a variety of respiratory complications that, if left untreated, can escalate to the point of requiring urgent or emergency care.

Tracheomalacia is often associated with esophageal atresia (a blockage of the esophagus) and tracheoesophageal fistula (an opening between the trachea and the esophagus), but it can occur without other conditions.

Patients with this condition who develop respiratory infections should be closely monitored by their healthcare provider.


Tracheomalacia in infants and newborns

Tracheomalacia is often found in babies between 4 and 8 weeks. Usually, the baby is born with the condition, but it is not until they begin to breathe enough air to cause wheezing that the state is noticeable.

Sometimes it is not harmful, and many children outgrow it. The condition can cause severe and ongoing problems with coughing, wheezing, apnea, and pneumonia.

What are the symptoms?

The most common symptoms of tracheomalacia are:

  • Wheezing that does not improve with bronchodilator therapy.
  • Unusual sounds when breathing.
  • Shortness of breath worsens with activity or when the person has a cold.
  • Sharp and noisy breathing.
  • Typical vital signs despite apparent respiratory problems.
  • Recurrent pneumonia.
  • Persistent cough
  • Temporary cessation of breathing, especially during sleep (apnea).
  • Breathing sounds during sleep may change as position changes and improves while sleeping.
  • Breathing difficulties are worse during food intake, coughing, crying, and upper respiratory infections.

What are the causes?

The specific mechanisms causing this disease are unknown but are currently being investigated. Tracheomalacia is extremely rare at any age; some babies are born with weak cartilage in the trachea, known as congenital tracheomalacia.

It can occur due to large blood vessels pressing on the airways, complications from tracheoesophageal fistula surgery, esophageal atresia, or prolonged use of a breathing tube.

How is it diagnosed?

If you have symptoms of tracheomalacia, your doctor will usually order a CT scan, lung function tests, and, depending on the results, a bronchoscopy or laryngoscopy.

Bronchoscopy is often required to diagnose tracheomalacia; this is a direct examination of the airway using a flexible camera. This test allows the doctor to diagnose the type of tracheomalacia, how severe the condition is, and its impact on your breathing ability.

Treatment options

Children often outgrow tracheomalacia by the time they are three years old; invasive treatments are generally not considered until this time has passed unless the condition is extremely severe.

A child will need to be closely monitored by their medical team and could benefit from a humidifier, chest physical therapy, and possibly a continuous positive airway pressure device.

If the child does not outgrow the condition or if they have a severe case of tracheomalacia, there are many surgical options available. The type of surgery offered will depend on the type and location of your tracheomalacia.

Respiratory distress in adults can be relieved by administering continuous positive airway pressure. This treatment option for tracheomalacia involves helping air under slight pressure through a mask while the patient is sleeping.

Rarely the severity of tracheomalacia requires surgical intervention with the placement of a stent to keep the airway open.


The prognosis for tracheomalacia is generally good, and in most cases, it resolves naturally, as the cartilage in the trachea strengthens over time.

This condition is scarce in any age group. In children, it is usually a manageable condition in which the symptoms diminish over time and are often eliminated by the time the child is three years old.

Several steps can help alleviate symptoms until they disappear naturally.

In rare cases where symptoms do not improve or are severe, then surgery may be required, as mentioned above, which in these cases has a high success rate. The condition is often challenging to manage in adults, is more likely to be severe, and has a high death rate.


Other more severe congenital disabilities related to tracheomalacia, such as heart defects, may be present. Additional risks of this disease include aspiration pneumonia, a life-threatening complication caused by inhaling food.

Upper respiratory infections require that a person with tracheomalacia be closely monitored and receive follow-up care from an ear, nose, and throat healthcare provider.

Adults diagnosed with tracheomalacia caused by a ventilator often develop serious lung problems.

Preventing tracheomalacia

Because the root cause has not been identified, it is unknown how to prevent tracheomalacia. However, severe complications of the condition can be prevented.

People affected by tracheomalacia should be carefully monitored for respiratory infections. Careful feeding of babies can prevent aspiration pneumonia.

Parents of children exhibiting any shortness of breath or breath sounds are advised to contact their healthcare provider immediately to help prevent problems associated with tracheomalacia.