Acquired tracheomalacia is a weakness and floppiness of the walls of the windpipe (trachea) that develops after birth.

See also: Congenital tracheomalacia

Acquired tracheomalacia is very uncommon. Rarely, babies, infants, and adults may develop the condition. It occurs when normal cartilage in the wall of the windpipe begins to break down.

Acquired, or secondary, tracheomalacia may result:

• From pressure on the airway by large blood vessels
• As a complication after surgical repair of a tracheo-esophagela fistula or esophageal atresia
• After having a breathing tube or tracheostomy for a long time

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

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

A procedure called a laryngoscopy provides the definitive diagnosis. 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 that may be performed include:

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

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

Continuous positive airway pressure (CPAP) may be necessary for adults with respiratory distress. Rarely, surgery is needed. A stent may be needed to hold the airway.

Aspiration pneumonia can occur from inhaling food contents.

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

Call your health care provider if you or your child breathes in an abnormal manner. It can become an urgent or emergency condition.

Secondary tracheomalacia

Rahbar R, Healy GB. Congenital disorders of the trachea. In: Cummings CW, Flint PW, Haughey BH, et al, eds. Otolaryngology: Head & Neck Surgery. 4th ed. Philadelphia, Pa: Mosby Elsevier; 2005:chap 191.

Updated by: Neil K. Kaneshiro, MD, MHA, Clinical Assistant Professor of Pediatrics, University of Washington School of Medicine. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.