Bay Area Pediatric Pulmonary Medical Corporation - BAPP

Malacia means soft. This Greek word is used to describe portions of the airway cartilage that are not as stiff as they should be. Three abnormalities are commonly diagnosed:

Laryngomalacia, showing soft cartilage in the larynx or voice box.

Tracheomalacia, soft cartilage in the trachea or the main windpipe.

Bronchomalacia, soft cartilage in the bronchi or smaller windpipe and branches.

All of these airways are meant to be stiff so that air passes through them easily when you breathe. If the airways are floppy or soft, they collapse with coughing and deep breathing. As you know, the chest is a closed space, and when we breathe in, we generate pressures that push and pull on our airways. Usually, laryngomalacia causes collapse of the airway during breathing in. Floppy airways deep in the chest, such as bronchomalacia or tracheomalacia of the lower trachea, cause collapse during breathing out.

Laryngomalacia is the most common cause of stridor, or noisy breathing when breathing in infants. About 15% of infants who have laryngomalacia will have an additional problem in their lower airways. It is easy to think of an example of a curtain at an open window. If the breeze is going in and out of the window, the curtains will move with the wind. If there is hardly any wind, the curtains do not move. If the wind picks up, the curtains will be pushed and pulled with the breeze. The curtains are like the walls of your airway. A breeze is like the air going in and out of your lungs. As the baby or child breathes, the airway tissues will move like the curtain. This motion can set up a vibration, which is heard as noisy breathing. Sometimes it is mistaken for congestion.

What to do. Laryngomalacia and tracheomalacia get better over time by themselves. The cartilage is present, but soft. Over 1 to 5 years, the cartilage stiffens and the noisy breathing tends to go away. Rarely the tissue is so floppy that babies are not able to feed and gain weight normally. In the most sever cases, other means of supporting the airway are required. In almost all cases, the airway stiffens without need for surgery.