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

This condition is generally congenital and appears at birth.

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

The weakened walls are likely to collapse and cause an 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 the ages of 4 and 8 weeks. Often the baby is born with the condition but it is not until they begin to breathe enough air to cause wheezing that the condition is noticeable.

Sometimes it is not harmful and many children outgrow it. Other times, 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 that gets worse with activity or when the person has a cold.
  • Sharp and noisy breathing.
  • Normal vital signs despite apparent respiratory problems.
  • Recurrent pneumonia.
  • Persistent cough
  • Temporary cessation of breathing, especially during sleep (apnea).
  • Breathing sounds during sleep that 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, which is known as congenital tracheomalacia.

It can occur as a result of large blood vessels pressing on the airways, complications from tracheoesphageal 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 what impact it is having on your breathing ability.

Treatment options

Children often outgrow tracheomalacia by the time they are 3 years old, because of this 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 administering 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.

Forecast

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 extremely rare in any age group. In children, it is usually a manageable condition in which the symptoms diminish over time and are often completely eliminated by the time the child is 3 years old.

There are several steps that can be taken to help alleviate symptoms until such time as 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. In adults, the condition is often difficult to manage, is more likely to be severe, and has a high death rate.

Survival

Other more serious birth defects 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 not known how to prevent tracheomalacia. However, serious complications of the condition can be prevented.

People affected by tracheomalacia should be carefully monitored when it comes to 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.