Tracheomalacia - acquired

Acquired tracheomalacia is very uncommon at any age. It occurs when normal cartilage in the wall of the windpipe begins to break down.

This form of tracheomalacia may result:

• When large blood vessels put pressure on the airway
• As a complication after surgery to repair birth defects in the windpipe and esophagus (the tube that carries food from the mouth to the stomach)
• After having a breathing tube or trachea tube (tracheostomy) for a long time

Symptoms of tracheomalacia include:

• Breathing problems that get worse with coughing, crying, or upper respiratory infections, such as a cold
• Breathing noises that may change when body position changes, and improve during sleep
• High-pitched breathing
• Rattling, noisy breaths

A physical exam confirms the symptoms. A chest x-ray may show narrowing of the trachea when breathing out. Even if the x-ray is normal, it is needed to rule out other problems.

A procedure called a laryngoscopy is used to diagnose the condition. This procedure allows the otolaryngologist (ear, nose, and throat doctor, or ENT) to see the structure of the airway and determine how severe the problem is.

Other tests may include:

• Airway fluoroscopy
• Barium swallow
• Bronchoscopy
• CT scan
• Lung function tests
• Magnetic resonance imaging (MRI)

The condition may improve without treatment. However, people with tracheomalacia must be monitored closely when they have respiratory infections.

Adults with breathing problems may need continuous positive airway pressure (CPAP). Rarely, surgery is needed. A hollow tube called a stent may be placed to hold the airway open.

Aspiration pneumonia (a lung infection) can occur from breathing in food or saliva.

Adults who develop tracheomalacia after being on a breathing machine often have serious lung problems.

Contact your health care provider if you or your child breathes in an abnormal way. Tracheomalacia can become an urgent or emergency condition.

Secondary tracheomalacia

Finder JD. Bronchomalacia and tracheomalacia. In: Kliegman RM, St. Geme JW, Blum NJ, Shah SS, Tasker RC, Wilson KM, eds. Nelson Textbook of Pediatrics. 21st ed. Philadelphia, PA: Elsevier; 2020:chap 416.

Green GE, Ohye RG. Diagnosis and management of tracheal anomalies and tracheal stenosis. In: Flint PW, Francis HW, Haughey BH, et al, eds. Cummings Otolaryngology: Head and Neck Surgery. 7th ed. Philadelphia, PA: Elsevier; 2021:chap 210.

Little BP. Tracheal diseases. In: Walker CM, Chung JH, eds. Muller's Imaging of the Chest. 2nd ed. Philadelphia, PA: Elsevier; 2019:chap 56.

Updated by: Charles I. Schwartz, MD, FAAP, Clinical Assistant Professor of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, General Pediatrician at PennCare for Kids, Phoenixville, PA. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.