My daughter was very close to having a trach placed this winter but we have so far avoided it. She was born 10 weeks premature and was intubated for her first 24 hours. This presumably caused scar tissue to form directly under her vocal cords, making treatment for it difficult. Her airway was 50% restricted (ended up being about 4 mm wide) so we needed to address the problem. We're in Boston and there are two doctors here and there's another in Cinncinatti that deal with specialized airway treatments. We ended up doing an experimental, but endoscopic, procedure that worked the second time the procedure was performed. (We were told that they'd try it three times before ruling it out as a possiblity.) If that didn't work we were going to go with either a trach or an airway reconstruction, which is a highly specialized and invasive procedure, but would ultimately correct the problem permanently and avoid the care needed for a trach.
If you go with the trach, take comfort in the fact that it's a straight forward procedure with a quick recovery and your little one will likely not be bothered by it one bit.Good luck!