Tracheomalacia/Laryngomalacia (loud breathing)

My three-year-old son has been diagnosed with tracheomalacia. He has had it since birth. He was adopted from Bulgaria about a year ago and we have little information about this.


Robert Steele

Robert W. Steele, MD, is a board certified pediatrician at St. John's Regional Health Center in Springfield, MO. He graduated from medical... Read more

For air to travel from the mouth to the lungs, it must go through the windpipe made up of the larynx or voice box and the trachea. Just before the air travels through the larynx, it passes a structure called the epiglottis. The epiglottis is a stiff piece of tissue that covers the windpipe when swallowing occurs. This keeps us from inhaling food when we eat. Next, the air goes through the trachea. The trachea is a tube made of muscles and other tissues which tend to be rather soft. Any tube that is soft will tend to collapse. The trachea, however, is stinted open by having rings made of stiffer material called cartilage surrounding this tube. You can feel these rings in your own neck by pushing on the mid part of the neck just below the Adam's apple.

Infants may be born with "loud breathing" or develop this soon after birth. Sometimes, this loud breathing is caused by minor obstruction within the airway. Two of the most common causes of this are laryngomalacia and tracheomalacia.


This is essentially a big word meaning "floppiness involving the larynx." The most common cause of this is the epiglottis is not very stiff. As the air rushes by during inspiration (breathing in), the epiglottis bends over to partially obstruct the opening to the larynx. The typically causes a loud noise when breathing in and begins around four to six weeks of age. It is rare that this abnormality causes any serious problems, however, it can sound quite disconcerting when the infant is crying. Therefore, the stress in the parent listening to this breathing is much greater than any problem the infant is experiencing. Most infants outgrow the loud breathing by 18-24 months.


As you can probably already guess by now, tracheomalacia is a big word meaning "floppiness involving the trachea." This floppiness is usually caused by a defect in the rings made of cartilage that keep the trachea open. Normally, the diameter of the trachea gets bigger when breathing in and gets smaller during exhalation (breathing out). Because of this, the collapse of the trachea generally occurs when breathing out. This is a nice distinguishing feature because laryngomalacia usually occurs when breathing in. The loud breathing usually gets louder with crying, lying on the back, and with viral illnesses. Rarely, this condition can cause such severe collapse of the airway that surgery is required to either fix the cartilage rings or perform a tracheostomy.

Most of the time, both of these problems may be confidently diagnosed simply based upon the history of when the loud breathing began and the physical exam. However, the only way to absolutely diagnose either of these two is to actually insert a tiny fiber-optic camera down into the larynx and trachea and look at what is occurring. This is usually done when other more serious causes of loud breathing are suspected.

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