Does Tracheomalacia cause inspiratory or expiratory stridor?

From the Guidelines

Tracheomalacia typically causes expiratory stridor, as the condition is characterized by a collapse of the airway during expiration due to softening of the tracheal cartilage 1.

Key Characteristics of Tracheomalacia

• The condition is often associated with a lateral splaying and collapse of the trachea at expiration 1
• An inspiratory elongated transverse diameter of the trachea, also known as a “lunate” or “lemon” shape, is highly correlated with tracheomalacia as confirmed by expiratory CT 1
• In some cases, inspiratory stridor may also be present, particularly in severe cases where the tracheal collapse is more pronounced

Clinical Presentation and Treatment

• The stridor associated with tracheomalacia is often exacerbated by respiratory infections 1
• Treatment may involve the use of humidified oxygen, bronchodilators such as albuterol, and in severe cases, continuous positive airway pressure (CPAP) therapy to maintain airway patency
• Tracheomalacia can be underestimated by static assessment in a deeply anaesthetized patient, and spontaneous respiration is critical for accurate assessment 1

From the Research

Tracheomalacia and Stridor

• Tracheomalacia is characterized by a softness of the tracheal cartilage that makes the airway more susceptible to collapse 2.
• The condition is often associated with expiratory stridor, which is a high-pitched sound that occurs during breathing out 3, 4, 5.
• Expiratory stridor is a common symptom of tracheomalacia, and it can be accompanied by other symptoms such as barking cough, recurrent respiratory tract infections, and difficulty breathing 3, 4, 5.
• The stridor associated with tracheomalacia is typically expiratory, meaning it occurs during exhalation, rather than inspiratory, which would occur during inhalation 3, 4, 5.

Clinical Presentation

• The clinical presentation of tracheomalacia can vary depending on the severity of the condition, but expiratory stridor is a common feature 3, 4, 5.
• Other symptoms may include wheezing, chronic cough, apnoeic attacks, and difficult breathing 4, 6.
• Tracheomalacia can be primary or secondary, and it may be associated with other conditions such as oesophageal atresia or vascular ring 4, 5.

Diagnosis and Management

• Diagnosis of tracheomalacia is typically made by flexible bronchoscopy or other dynamic imaging techniques such as low-contrast volume bronchography, computed tomography, or magnetic resonance imaging 5.
• Management of tracheomalacia may be medical or surgical, depending on the nature and severity of the lesions, but the evidence base for any therapy is limited 5.
• Surgical options may include aortopexy or posterior tracheopexy, tracheal resection of short affected segments, internal stents, and external airway splinting 3, 5.