Dealing with 'Tracheomalacia - Congenital vs Acquired'
Authored by Dr.Ashish Omprakash Goyal
Introduction
Tracheomalacia(TM) is a weakening of the trachea causing notable narrowing of the windpipe (trachea) and thereby leading to airway obstruction, especially during sneezing, coughing or feeding. It is a structural abnormality of the tracheal cartilage, rather a disease. TM is an ultimate result of an undeveloped cartilage in the wind pipe and so walls remains floppy, instead of being rigid (normal structure); however, TM may develop after the birth in later phases of life (acquired). Based on several factors, including clinical features, histology and endoscopic characteristics, TM can be broadly classified as: • Type I: These are congenital or intrinsic tracheal abnormalities (present during the birth). • Type II: These represent extrinsic defects that cause excess pressure on the trachea and so the airway obstruction occurs. • Type III: It is acquired form of the TM (develops after the birth), possibly due to chronic illnesses, or long term intubation and causes breakdown of the walls of the trachea. Causes Acquired TM is a rare abnormality affecting babies, infants and adults. Common causes of acquired TM may include:
Excess pressure on the airways, may be exerted by blood vessels • As an adverse effect of surgery (especially Tracy-esophageal fistula surgery) • Having a breathing tube for a longer duration Congenital TM is often linked to several congenital defects, including heart defects, esophageal defects and developmental delay. Symptoms Patients having TM may present with following common signs and symptoms: • Obstructed breathing (especially while activities exerting pressure on the trachea) • Altered breathing sound varying with position • High-pitch noise during random breathing • Rattling sound When does one see a doctor? It is time to visit your health care adviser if you see your child breathing with abnormal noise or having breathing difficulty. Diagnosis Diagnosis of TM may require assessment of medical history, imaging tests and several laboratory investigations. • Physical examination: To examine physical symptoms. • Assessment of clinical history: To assess family history of chronic respiratory infections that may be responsible for TM. • Chest x-ray/ Magnetic resonance imaging (MRI) and CT scan: Helps to detect narrowing of a wind pipe and the extent of its narrowing. • Laryngoscopy: Helps to probe for the extent of severity. • Airway fluoroscopy: Helps detect the exact cause of altered noise during breathing. • Barium swallow: To examine structural defects in the esophagus and GI tract so that structural defect can be seen in these parts. • Bronchoscopy: To detect abnormality causing TM by looking into the lung airways. • Lung function test: To examine lung functions. •
Treatment Usually, congenital TM vanishes on its own by the time the child reaches his/ her second birthday. However, acquired TM and those which do not go on its own may need certain treatment approaches to manage its symptoms. These may include: Warm air therapy: To simplify the breathing process in children with TM with the help of humidifiers. Continuous Positive Airway Pressure (CPAP): It utilizes a device to keep the airway open so that he/ she can breathe with ease. It is especially indicated as a short term intervention. Surgery: Surgical approach to manage TM is a rare practice, especially indicated in those who develop TM in later stages of their life and symptoms do not go on its own. Further, a surgery to correct TM is needed when: • The patient does not respond to conservative measures
Diffuse TM • Reflex apnea • Recurrent pneumonia • Inability of intubation and so on. Right and suitable surgical approach may be chosen from following procedures: • Aortopexy: A surgery to remove excess pressure on the airways by dislocating nearby tissues exerting pressure. • A surgery to remove particular part of a trachea that is troubling • A procedure of placing a device (stent) to keep the trachea open Alternative treatments: As such, there are no alternative approaches listed specially for managing TM. However, in general, the following approaches may help to correct and improve his/ her breathing abnormality: • Breathing exercises: It should be practiced by – inhaling (7 counts), holding (4 counts) and exhaling (8 counts) • Pranayama: To be practiced as per expert’s advice, to improve breathing that will also fetch many other advantages. • Yogasana: Especially stretching positions are indicated, however must be done with the expert’s guidance. Diet and nutrition: Following diet and nutrition tips may be recommended to improve general breathing and resolve breathing related issues to some extent: • Eating plenty of fresh fruits and vegetables (especially antioxidant-rich). E.g. Berries, orange, lemon, mango, green- leafy vegetables, potatoes and so on. • Including nuts and seeds in your daily diet. E.g. almonds, Brazil nuts, sunflower seeds, and flaxseed etc. • Eating cold water fish. E.g. Albacore tuna and Herring • Having vital supplements including minerals, multivitamins, omega 3 fatty acids, etc. with the doctor’s advice. Complications: Poorly controlled TM may lead to complications like aspiration pneumonia and severe lung related issues. Further, continuously disturbing symptoms may irritate you and may affect the quality of life. •
Prevention None of the measure can assure complete prevention of TM but several approaches may help one to prevent complications associated with TM. These may include: • Close monitoring of TM patients while treating respiratory infections (RTIs) • Feeding carefully • Adopting measures to prevent severe infections • Avoiding feeding when baby is lying • Staying in upright position for a while after eating. However, some new techniques can help to prevent deprivation of oxygen (causing suffocation, unconsciousness) associated with TM.