Unknown-5Tracheomalacia (from trachea and the Greek μαλακία, softening) is a condition characterized by flaccidity of the tracheal support cartilage which leads to tracheal collapse especially when increased airflow is demanded.

The trachea normally dilates slightly during inspiration and narrows slightly during expiration. These processes are exaggerated in tracheomalacia, leading to airway collapse on expiration. The usual symptom of tracheomalacia is expiratory stridor or laryngeal crow.  Sometimes called “Dying Spells”.  These are markedly worse with upper respiratory infections and there is a high incidence of pneunonia in these patients.

If the condition extends further to the bronchi (if there is also bronchomalacia), it is termed tracheobronchomalacia. The same condition can also affect the larynx, which is called laryngomalacia.  The conditions seem to be unrelated other than pathophysiologically.

Unknown-6This condition almost always seems to resolve in the first year of life.  It is far more common in Down Syndrome.  Typically you should have a 4.5/1 ratio of arch to membranous trachea according to Bruce Benjamin.

Diagnosis is best made with an apneic laryngotracheobronchoscopy.  Treatment is best facilitated with CPAP, BIPAP, or a trach for high disease.  Airway stents have been disappointing.   I would always treat these people for GERD with prolonged PPI.

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