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Laryngomalacia and Tracheomalacia

Tracheomalacia is defined as flaccidity of the tracheal walls secondary to defective cartilaginous rings. It is a self-resolving disorder because cartilagenous tissue develops to support the airway.

1. Etiology
   
   1. idiopathic
      
   2. secondary to intubation
      
   3. associated with tracheoesophogeal fistulas (TEF)
      
   4. secondary to external compression due to mediastinal mass or vascular ring
   
   
2. Symptoms
   
   1. Usually presents shortly after birth with expiratory noises or wheezes. Since most of the trachea is within the thorax, the trachea will collapse during expiration when there is increased intrathoracic pressure. Patients have chronic wheezing that does not respond to bronchodilators and anti-inflammatory drugs. Symtoms will improve in the prone position. The lungs remain clear.
      
3. Differential diagnosis
   
   1. Vascular ring
      
   2. Mass
      
   3. Stenosis from a foreign body
      
4. Diagnosis
   
   1. Usually diagnosis is made clinically when the course is benign. Definitive diagnosis by fluoroscopy where the collapse of the trachea is observed or bronchoscopy.
      
5. Complications
   
   1. respiratory distress is rare
      
   2. FTT may be associated if there is a feeding problems

1. There is a flaccid epiglottis and aryepiglottal folds that prolapse into the airway during inspiration. With cartilagenous development, symptoms will resolve.
   
2. Clinically there is inspiratory stridor and there may be hoarseness, aphonia and sometimes retractions. Usually present shortly after birth and is worse with crying, URIs, when supine.
   
3. Differential diagnosis
   
   1. Hypocalcemia with laryngospasm
      
   2. edema secondary to trauma or intubation
      
   3. Mass or intraluminal web.
      
   4. laryngopapillomatosis
      
   5. vocal cord abnormalities
      
4. Diagnosis- usually clinically diagnosed but some cases necessitate fluoroscopy or bronchoscopy.
   
5. Complications
   
   1. rarely respiratory distress and feeding difficulties

Both laryngomalacia and tracheomalacia usually follow a benign clinically course. They are rarely associated with cyanosis, hypercarbia, or failure to thrive. The symptoms may get worse during URIs and may be accentuated by the supine position and improve in the prone position. They usually resolve at about 18-24 months but some may have symptoms longer. Rarely is intubation or tracheotomy necessary.

References

1. Paston, Francine and Bye, Michael. Tracheomalacia. Pediatrics in Review September 1996
2. Vicencio A and Parikh S. Laryngomalacia and Tracheomalacia: Common Dynamic Airway Lesions. Pediatrics in Review April 2006
   

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