DISCUSSION: The actual prevalence of TM is unknown, however some degree has been identified in up to 22% of patients undergoing bronchoscopy2. Common causes of TM in adults include COPD, prolonged intubation, recurrent infections, irritant exposure, and GERD. Symptoms often first manifest under conditions of stress, during infections, on exertion, or with valsalva maneuvers. Bronchoscopy is the gold standard for diagnosis but newer modalities like dynamic imaging CT have also proven to be sensitive in diagnosing TM. Asymptomatic patients must be monitored for progression. Symptomatic patients amenable to surgical intervention should be considered for a silicon stent trial, and those with favorable response should be considered for definitive surgical correction1. Patients not responding to stent trials, or poor surgical candidates may pursue other options such as NIPPV, or tracheostomy for the most severe cases1.