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Tracheomalacia: Treatment, symptoms, advice and help

About Tracheomalacia

Tracheomalacia is a condition in which there is insufficient cartilage around the trachea to maintain the airway patency throughout the respiratory cycle. This leads to tracheal collapse during expiration. It is a common cause of persistent wheezing in infancy.

Tracheomalacia: Incidence, age and sex

Although primary tracheomalacia is seen frequently in premature infants, most affected patients are born at term. It is principally a disorder of infants, with a male, female ratio of 2:1.

Signs and symptoms of tracheomalacia: Diagnosis

The usual symptom of tracheomalacia is expiratory stridor or laryngeal crow. The dominant finding is a low-pitched monophonic wheezing, most prominent over the central airways. Parents often describe persistent respiratory congestion even in the absence of a viral respiratory infection. The definitive diagnosis of tracheomalacia is established by flexible or rigid bronchoscopy. Fluoroscopy may demonstrate dynamic collapse and can avoid the need for invasive diagnostic techniques. MRI is especially useful when there is a possibility of vascular ring and should be performed when a right aortic arch is seen on plain film radiography.

Causes and prevention of tracheomalacia

There are two types of tracheomalacia based on the cause- Primary Tracheomalacia is caused by congenital absence of tracheal-supporting cartilages Secondary tracheomalacia is caused by oesophageal atresia / tracheo-oesophageal fistula, vascular rings (double aortic arch), tracheal compression from an aberrant innominate artery or mediastinal masses, abnormally soft tracheal cartilages associated with connective tissue disorders, prolonged mechanical ventilation and chronic lung disease.

Tracheomalacia: Complications

Persons with tracheomalacia must be monitored closely when they have respiratory infections. Babies born with tracheomalacia may have other congenital abnormalities such as heart defects, developmental delay, or gastroesophageal reflux. Aspiration pneumonia may occur from inhaling food.

Tracheomalacia: Treatment

Congenital tracheomalacia generally goes away on its own by the age of 18-24 months. As the tracheal cartilage gets stronger and the trachea grows, the noisy respirations and breathing difficulties gradually stop. Babies with tracheomalacia must be closely monitored when they have respiratory infections. Most infants respond well to humidified air, careful feedings, and antibiotics for infections. Postural drainage may help with clearance of secretions .ß-Adrenergic agents should be avoided in the absence of asthma. Nebulised ipratropium bromide may be useful. Surgical approach (aorticopexy and bronchepexy) is rarely required and only for patients who have life-threatening apnea, cyanosis and bradycardia (cyanotic spells”) from airway obstructions.